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  Subjects -> PHARMACY AND PHARMACOLOGY (Total: 575 journals)
Showing 1 - 200 of 253 Journals sorted by number of followers
Nature Reviews Drug Discovery     Full-text available via subscription   (Followers: 333)
International Journal of Drug Policy     Hybrid Journal   (Followers: 249)
Journal of Clinical Oncology     Hybrid Journal   (Followers: 246)
Journal of Medicinal Chemistry     Hybrid Journal   (Followers: 160)
Journal of Pharmaceutical Sciences     Hybrid Journal   (Followers: 159)
Drugs     Full-text available via subscription   (Followers: 143)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 98)
Pharmaceutical Research     Hybrid Journal   (Followers: 94)
European Journal of Pharmaceutical Sciences     Hybrid Journal   (Followers: 87)
Drug Safety     Full-text available via subscription   (Followers: 84)
Annals of Pharmacotherapy     Hybrid Journal   (Followers: 56)
Biomaterials     Hybrid Journal   (Followers: 54)
Clinical Pharmacology & Therapeutics     Hybrid Journal   (Followers: 45)
Regulatory Toxicology and Pharmacology     Hybrid Journal   (Followers: 42)
Journal of Controlled Release     Hybrid Journal   (Followers: 38)
Annual Review of Pharmacology and Toxicology     Full-text available via subscription   (Followers: 38)
International Journal of Pharmaceutics     Hybrid Journal   (Followers: 37)
European Journal of Pharmaceutics and Biopharmaceutics     Hybrid Journal   (Followers: 35)
Clinical Therapeutics     Hybrid Journal   (Followers: 34)
Pharmacoepidemiology and Drug Safety     Hybrid Journal   (Followers: 33)
British Journal of Clinical Pharmacology     Hybrid Journal   (Followers: 32)
Drug Development and Industrial Pharmacy     Hybrid Journal   (Followers: 30)
AAPS Journal     Hybrid Journal   (Followers: 28)
Clinical Pharmacokinetics     Full-text available via subscription   (Followers: 27)
PharmacoEconomics     Full-text available via subscription   (Followers: 26)
Journal of Pharmacy and Pharmacology     Full-text available via subscription   (Followers: 26)
Critical Reviews in Toxicology     Hybrid Journal   (Followers: 25)
Toxicology and Applied Pharmacology     Hybrid Journal   (Followers: 24)
Journal of Clinical Psychopharmacology     Hybrid Journal   (Followers: 24)
International Journal of Pharmacy Practice     Full-text available via subscription   (Followers: 24)
Journal of Pain & Palliative Care Pharmacotherapy     Hybrid Journal   (Followers: 23)
Chemical Research in Toxicology     Hybrid Journal   (Followers: 22)
Journal of Pharmacokinetics and Pharmacodynamics     Hybrid Journal   (Followers: 22)
Trends in Pharmacological Sciences     Full-text available via subscription   (Followers: 20)
American Journal of Cardiovascular Drugs     Hybrid Journal   (Followers: 20)
Journal of Applied Toxicology     Hybrid Journal   (Followers: 19)
Pharmaceutical Development and Technology     Hybrid Journal   (Followers: 19)
Journal of Clinical Pharmacology     Hybrid Journal   (Followers: 19)
Clinical Trials     Hybrid Journal   (Followers: 18)
Toxicology     Hybrid Journal   (Followers: 18)
Journal of Pharmaceutical and Biomedical Analysis     Hybrid Journal   (Followers: 18)
Clinical Toxicology     Hybrid Journal   (Followers: 18)
International Journal of Toxicology     Hybrid Journal   (Followers: 17)
Critical Reviews in Clinical Laboratory Sciences     Hybrid Journal   (Followers: 16)
Journal of Clinical Pharmacy and Therapeutics     Hybrid Journal   (Followers: 16)
Journal of Natural Products     Hybrid Journal   (Followers: 16)
Pharmaceutical Statistics     Hybrid Journal   (Followers: 15)
Toxicology Letters     Hybrid Journal   (Followers: 15)
Journal of Pharmacy Practice     Hybrid Journal   (Followers: 15)
Psychopharmacology     Hybrid Journal   (Followers: 15)
European Journal of Clinical Pharmacology     Hybrid Journal   (Followers: 14)
Cardiovascular Drugs and Therapy     Hybrid Journal   (Followers: 14)
Basic & Clinical Pharmacology & Toxicology     Hybrid Journal   (Followers: 14)
Drug and Chemical Toxicology     Hybrid Journal   (Followers: 13)
Journal of the American Pharmacists Association     Full-text available via subscription   (Followers: 13)
Current Medicinal Chemistry     Hybrid Journal   (Followers: 13)
American Journal of Therapeutics     Hybrid Journal   (Followers: 13)
Journal of Oncology Pharmacy Practice     Hybrid Journal   (Followers: 13)
Drug Discovery Today: Technologies     Full-text available via subscription   (Followers: 12)
Current Pharmaceutical Design     Hybrid Journal   (Followers: 12)
Seminars in Hematology     Hybrid Journal   (Followers: 12)
Biopharmaceutics and Drug Disposition     Hybrid Journal   (Followers: 11)
Drug Development Research     Hybrid Journal   (Followers: 11)
Drug Metabolism and Disposition     Hybrid Journal   (Followers: 11)
Journal of Psychopharmacology     Hybrid Journal   (Followers: 11)
Toxicology in Vitro     Hybrid Journal   (Followers: 11)
Journal of Separation Science     Hybrid Journal   (Followers: 10)
Seminars in Oncology Nursing     Full-text available via subscription   (Followers: 10)
CNS Drugs     Full-text available via subscription   (Followers: 10)
Biochemical Pharmacology     Hybrid Journal   (Followers: 10)
Drugs & Aging     Full-text available via subscription   (Followers: 10)
Current Pharmaceutical Biotechnology     Hybrid Journal   (Followers: 10)
Food Additives & Contaminants Part A     Hybrid Journal   (Followers: 9)
Clinical Research and Regulatory Affairs     Hybrid Journal   (Followers: 9)
Journal of Pharmacology and Experimental Therapeutics     Hybrid Journal   (Followers: 9)
Journal of Medical Marketing     Hybrid Journal   (Followers: 9)
Biometrical Journal     Hybrid Journal   (Followers: 9)
Environmental Toxicology and Pharmacology     Hybrid Journal   (Followers: 9)
European Neuropsychopharmacology     Hybrid Journal   (Followers: 9)
Medicinal Chemistry     Hybrid Journal   (Followers: 9)
Prescriber     Hybrid Journal   (Followers: 9)
Drugs & Therapy Perspectives     Full-text available via subscription   (Followers: 9)
ChemMedChem     Hybrid Journal   (Followers: 9)
Current Opinion in Pharmacology     Hybrid Journal   (Followers: 9)
Inhalation Toxicology     Hybrid Journal   (Followers: 8)
Antiviral Research     Hybrid Journal   (Followers: 8)
Drug Metabolism Reviews     Hybrid Journal   (Followers: 8)
Progress in Neuro-Psychopharmacology and Biological Psychiatry     Hybrid Journal   (Followers: 8)
Human & Experimental Toxicology     Hybrid Journal   (Followers: 8)
BioDrugs     Full-text available via subscription   (Followers: 8)
Drug Delivery     Open Access   (Followers: 8)
Expert Review of Pharmacoeconomics & Outcomes Research     Full-text available via subscription   (Followers: 8)
European Journal of Pharmacology     Hybrid Journal   (Followers: 8)
Journal of Veterinary Pharmacology and Therapeutics     Hybrid Journal   (Followers: 7)
Experimental and Clinical Psychopharmacology     Full-text available via subscription   (Followers: 7)
Frontiers in Drug Design & Discovery     Hybrid Journal   (Followers: 7)
Clinical and Experimental Pharmacology and Physiology     Hybrid Journal   (Followers: 7)
Journal of Pharmacological and Toxicological Methods     Hybrid Journal   (Followers: 7)
Epilepsy Research     Hybrid Journal   (Followers: 7)
Clinical Drug Investigation     Full-text available via subscription   (Followers: 7)
Toxicology Mechanisms and Methods     Hybrid Journal   (Followers: 7)
Scandinavian Journal of Clinical and Laboratory Investigation     Hybrid Journal   (Followers: 7)
Journal of Cardiovascular Pharmacology     Hybrid Journal   (Followers: 7)
Toxicology and Industrial Health     Hybrid Journal   (Followers: 6)
Skin Pharmacology and Physiology     Full-text available via subscription   (Followers: 6)
AAPS PharmSciTech     Hybrid Journal   (Followers: 6)
Anti-Inflammatory & Anti-Allergy Agents in Medicinal Chemistry     Hybrid Journal   (Followers: 6)
Current Drug Discovery Technologies     Hybrid Journal   (Followers: 6)
Current Therapeutic Research     Open Access   (Followers: 6)
Expert Review of Cardiovascular Therapy     Full-text available via subscription   (Followers: 6)
Current Drug Delivery     Hybrid Journal   (Followers: 6)
Current Drug Metabolism     Hybrid Journal   (Followers: 5)
Investigational New Drugs     Hybrid Journal   (Followers: 5)
Toxicon     Hybrid Journal   (Followers: 5)
Medicinal Research Reviews     Hybrid Journal   (Followers: 5)
Anti-Infective Agents     Hybrid Journal   (Followers: 5)
Expert Review of Anti-infective Therapy     Full-text available via subscription   (Followers: 5)
Expert Review of Molecular Diagnostics     Full-text available via subscription   (Followers: 5)
Current Cancer Therapy Reviews     Hybrid Journal   (Followers: 5)
Neuropharmacology     Hybrid Journal   (Followers: 5)
Fitoterapia     Hybrid Journal   (Followers: 5)
Immunopharmacology and Immunotoxicology     Hybrid Journal   (Followers: 4)
Journal of Cardiovascular Pharmacology and Therapeutics     Hybrid Journal   (Followers: 4)
Planta Medica     Hybrid Journal   (Followers: 4)
Current Vascular Pharmacology     Hybrid Journal   (Followers: 4)
Reviews of Physiology, Biochemistry and Pharmacology     Hybrid Journal   (Followers: 4)
Journal of Child and Adolescent Psychopharmacology     Hybrid Journal   (Followers: 4)
International Journal of Pharmaceutical and Healthcare Marketing     Hybrid Journal   (Followers: 4)
Pharmaceutical Medicine     Full-text available via subscription   (Followers: 4)
Journal of Pain Management & Medicine     Open Access   (Followers: 4)
Cancer Chemotherapy and Pharmacology     Hybrid Journal   (Followers: 4)
Journal of Labelled Compounds and Radiopharmaceuticals     Hybrid Journal   (Followers: 4)
Inpharma Weekly     Full-text available via subscription   (Followers: 4)
Inflammation Research     Hybrid Journal   (Followers: 4)
CNS Drug Reviews     Open Access   (Followers: 4)
Therapeutic Drug Monitoring     Hybrid Journal   (Followers: 3)
Research in Social and Administrative Pharmacy     Hybrid Journal   (Followers: 3)
Current Drug Therapy     Hybrid Journal   (Followers: 3)
Chemotherapy     Full-text available via subscription   (Followers: 3)
Cardiovascular Therapeutics     Open Access   (Followers: 3)
International Journal of Neuropsychopharmacology     Open Access   (Followers: 3)
Pharmacopsychiatry     Hybrid Journal   (Followers: 3)
Pharmacology & Therapeutics     Hybrid Journal   (Followers: 3)
ASSAY and Drug Development Technologies     Hybrid Journal   (Followers: 3)
Physiology International     Full-text available via subscription   (Followers: 3)
Journal of Aerosol Medicine and Pulmonary Drug Delivery     Hybrid Journal   (Followers: 3)
Human Psychopharmacology Clinical and Experimental     Hybrid Journal   (Followers: 3)
Frontiers in Medicinal Chemistry     Hybrid Journal   (Followers: 3)
Acta Pharmacologica Sinica     Hybrid Journal   (Followers: 3)
Drug Resistance Updates     Hybrid Journal   (Followers: 3)
Microbial Drug Resistance     Hybrid Journal   (Followers: 3)
Journal of Infection and Chemotherapy     Hybrid Journal   (Followers: 3)
Journal of Ethnopharmacology     Hybrid Journal   (Followers: 3)
Current Pharmacogenomics and Personalized Medicine     Hybrid Journal   (Followers: 3)
Canadian Journal of Physiology and Pharmacology     Hybrid Journal   (Followers: 2)
International Immunopharmacology     Hybrid Journal   (Followers: 2)
Journal of Drug Targeting     Hybrid Journal   (Followers: 2)
BMC Pharmacology     Open Access   (Followers: 2)
Vascular Pharmacology     Hybrid Journal   (Followers: 2)
Journal of Inflammation     Open Access   (Followers: 2)
Biomedicine & Pharmacotherapy     Full-text available via subscription   (Followers: 2)
Clinical Neuropharmacology     Hybrid Journal   (Followers: 2)
Toxicological & Environmental Chemistry     Hybrid Journal   (Followers: 2)
Inflammopharmacology     Hybrid Journal   (Followers: 2)
The Brown University Psychopharmacology Update     Hybrid Journal   (Followers: 2)
Behavioural Pharmacology     Hybrid Journal   (Followers: 2)
Archiv der Pharmazie     Hybrid Journal   (Followers: 2)
Fundamental & Clinical Pharmacology     Hybrid Journal   (Followers: 2)
International Clinical Psychopharmacology     Hybrid Journal   (Followers: 2)
Pulmonary Pharmacology & Therapeutics     Hybrid Journal   (Followers: 2)
Pharmacological Reviews     Hybrid Journal   (Followers: 2)
Molecular Pharmacology     Hybrid Journal   (Followers: 2)
Pharmacology Biochemistry and Behavior     Hybrid Journal   (Followers: 2)
Journal of Microencapsulation: Microcapsules, Liposomes, Nanoparticles, Microcells, Microspheres     Hybrid Journal   (Followers: 2)
Letters in Drug Design & Discovery     Hybrid Journal   (Followers: 2)
Drugs in R & D     Full-text available via subscription   (Followers: 2)
Journal of Neuroimmune Pharmacology     Hybrid Journal   (Followers: 1)
Current Pharmaceutical Analysis     Hybrid Journal   (Followers: 1)
Current Enzyme Inhibition     Hybrid Journal   (Followers: 1)
Journal of Texture Studies     Hybrid Journal   (Followers: 1)
Pharmacogenetics and Genomics     Hybrid Journal   (Followers: 1)
Particulate Science and Technology: An International Journal     Hybrid Journal   (Followers: 1)
Current Neuropharmacology     Hybrid Journal   (Followers: 1)
Pharmacological Research     Hybrid Journal   (Followers: 1)
Pharmaceutical Biology     Open Access  
Journal of Liposome Research     Hybrid Journal  
Toxin Reviews     Hybrid Journal  
Kaohsiung Journal of Medical Sciences     Open Access  
Redox Report     Open Access  
Pharmacology     Full-text available via subscription  
PharmacoEconomics & Outcomes News     Full-text available via subscription  
Pharmaceutical Chemistry Journal     Hybrid Journal  
NeuroMolecular Medicine     Hybrid Journal  
Journal of Ocular Pharmacology and Therapeutics     Hybrid Journal  
Harm Reduction Journal     Open Access  
Current Nanoscience     Hybrid Journal  
Infectious Disorders - Drug Targets     Hybrid Journal  
Current Bioactive Compounds     Hybrid Journal  
Cancer Biotherapy & Radiopharmaceuticals     Hybrid Journal  
Autonomic & Autacoid Pharmacology     Hybrid Journal  

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Journal of Pharmacy Practice
Journal Prestige (SJR): 0.413
Citation Impact (citeScore): 1
Number of Followers: 15  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0897-1900 - ISSN (Online) 1531-1937
Published by Sage Publications Homepage  [1176 journals]
  • Acknowledgment to Reviewers: 2022

    • Free pre-print version: Loading...

      Pages: 180 - 184
      Abstract: Journal of Pharmacy Practice, Volume 36, Issue 1, Page 180-184, February 2023.

      Citation: Journal of Pharmacy Practice
      PubDate: 2023-02-02T02:48:36Z
      DOI: 10.1177/08971900231155261
      Issue No: Vol. 36, No. 1 (2023)
       
  • Demographic and Clinical Predictors of Pharmacist-Administered Pediatric
           Influenza Immunization

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      Authors: Dana M. Gates, Steven A. Cohen, Kelly Orr, Aisling R. Caffrey
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: Pediatricians’ offices are primary locations for pediatric influenza vaccination; however, pharmacists are also well-positioned as immunizers. Considering the current COVID-19 pandemic and Public Readiness and Emergency Preparedness (PREP) Act, pharmacists’ authority to vaccinate children has been recently expanded. Methods: We used the de-identified Optum ClinformaticsTM Data Mart database to identify demographic and clinical predictors of pharmacist-administered pediatric influenza vaccination compared with influenza vaccination in pediatricians’ offices. Procedures codes for influenza vaccinations among children were captured for the 2016-2017 influenza season. Logistic regression was used to identify significant predictors. Results: We included 336 841 children receiving influenza vaccines by a pharmacist (5.2%) or in pediatricians’ offices (94.8%). The following significant predictors were identified: older pediatric age groups (13-17 years odds ratio [OR] 91.51, 5-12 years OR 35.41), states allowing pharmacist-administered influenza vaccination at younger ages (no age restrictions OR, 26.68, minimum age 2-4 years old OR, 33.76), influenza vaccination outside of pediatricians’ offices in the previous year (pharmacist-administered OR, 22.18, convenience care OR 4.15, emergency care OR 1.69), geographic region (South OR, 2.02, Midwest OR 1.60, and West OR 1.38), and routine health exam or follow-up in the prior 6-months (OR, 1.59). Conclusions: The strongest drivers of pharmacist-administered pediatric influenza vaccination were older pediatric age, more lenient minimum age restrictions, and previous influenza vaccination in a pharmacy. Due to the COVID-19 pandemic, the PREP Act, and forthcoming pediatric COVID-19 vaccines for children, pharmacists may play a greater role in pediatric vaccination resulting in sustained changes in pediatric vaccination practices.
      Citation: Journal of Pharmacy Practice
      PubDate: 2023-02-01T09:04:49Z
      DOI: 10.1177/08971900231155223
       
  • A Review of Levodopa Formulations for the Treatment of Parkinson’s
           Disease Available in the United States

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      Authors: Clare Livingston, Laura Monroe-Duprey
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Purpose: The safety and efficacy of levodopa formulations are evaluated to inform clinical decision making for the treatment of Parkinson’s disease. Summary: Levodopa is a cornerstone of treatment for Parkinson’s disease due to its proven efficacy. Although many patients can initially be managed using immediate release tablets, as their disease progresses they often require escalating doses as well as more frequent dosing to prevent wearing off effects. Additionally, patients who experience time in the off state may struggle with the delay between medication administration and onset of action. Therefore, to increase patient convenience as well as to enhance the pharmacokinetic profile of the levodopa, several other formulations have been developed. Levodopa coformulated with carbidopa is supplied as immediate release tablets, oral disintegrating tablets, controlled release tablets, extended release capsules, and a continuous enteral solution. Additionally, there is a levodopa inhalation powder available. As a result of their different absorption profiles, each formulation has unique safety and efficacy attributes. Consequently, while this expansion of levodopa formulations has substantially increased treatment options for patients, it has also increased the complexity of medical decision making for patients, providers, and health systems alike. Conclusion: Knowledge of the different pharmacokinetic, safety and efficacy profiles of the available levodopa formulations is critical for the effective management of Parkinson’s disease on both the individual patient and population levels.
      Citation: Journal of Pharmacy Practice
      PubDate: 2023-01-27T09:06:14Z
      DOI: 10.1177/08971900221151194
       
  • Rhabdomyolysis Suspected to be Caused by Eravacycline Therapy: A Case
           Report

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      Authors: Madeline G. Belk, Pam M. Ku, David L. George, Athena L. V. Hobbs
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Eravacycline is approved by the U.S. Food and Drug Administration (FDA) for the treatment of complicated intra-abdominal infections. It is a novel, fully synthetic fluorocycline antibiotic belonging to the tetracycline class with a broad-spectrum of activity and an appealing side effect profile. This report describes a 74-year-old female who presented to the hospital with non-ST-elevation myocardial infarction (NSTEMI) requiring coronary artery bypass graft surgery. After surgery, she developed a sternal wound infection that grew multidrug resistant organisms, leading to a much longer than anticipated hospital stay. Eravacycline was eventually added to the antimicrobial regimen for the persistent infection. Shortly after therapy with eravacycline began, the patient started experiencing muscle pain and the creatine phosphokinase (CPK) level was noted to be elevated. Other causes, such as concomitant administration of an HMG-CoA reductase inhibitor, were explored in this case but not thought to be the cause of rhabdomyolysis. The patient’s CPK dropped considerably upon discontinuation of the novel antibiotic, and symptoms resolved. The adverse drug event was reported to the drug manufacturer; however, there are no reports up until this time that address a possible relationship between eravacycline administration and the development of rhabdomyolysis.
      Citation: Journal of Pharmacy Practice
      PubDate: 2023-01-19T05:39:58Z
      DOI: 10.1177/08971900221117872
       
  • Out With the Old, in With the New: What Rising Pharmacists Need to Know
           About Vancomycin Therapeutic Drug Monitoring in Adults

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      Authors: Jessica Armstrong Cook, Jonathan Pouliot, Robin Parker
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      The goal of this commentary is to provide recent pharmacy school graduates and student pharmacists completing APPEs the essential background for correct vancomycin therapeutic drug monitoring (TDM) in the inpatient setting.
      Citation: Journal of Pharmacy Practice
      PubDate: 2023-01-06T04:17:36Z
      DOI: 10.1177/08971900221150321
       
  • Medication Profiles at Hospital Discharge Predict Poor Outcomes After
           Acute Ischemic Stroke

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      Authors: Megan E. Barra, Jennifer M. Giulietti, Julie A. DiCarlo, Kimberly S. Erler, James Krenz, Russel J. Roberts, David J. Lin
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Objectives: To examine the relationship between medications prescribed during the first 6-months post-stroke and functional outcome. Materials and Methods: A retrospective analysis of ischemic stroke survivors enrolled in an observational stroke recovery study from June-2017 to July-2019 was performed. Survivors with favorable outcomes (modified rankin scale (mRS) score 0-2) were compared to those with unfavorable outcomes (mRS ≥3) 6-months after stroke on the following: discharge medication classes prescribed, achievement of recommended targets for blood pressure control, glycemic control, and LDL ≤70 mg/dL, medication changes, medication interactions, and medication list discrepancies. Results: Unfavorable 6-month outcomes occurred in 36/78 (46.2%) of survivors. Survivors with unfavorable outcomes were more likely to be prescribed a central nervous system-acting agent (97.2% vs 71.4%; P = .0022) and/or an anti-hyperglycemic agent (25.0% vs 9.5%; P = .009) at discharge. After adjustment of baseline covariates, total number of medications prescribed was associated with unfavorable 6-month outcomes (OR 1.13, 95% CI 1.0-1.28). Secondary stroke prevention measures were not achieved in a high proportion of survivors. Medication changes during 6-month follow up were common and survivors with unfavorable outcomes were more likely to have clinically significant drug-drug interactions. Discussion: At 6-months, survivors with unfavorable outcomes were found to be prescribed more medications, particularly central nervous system-acting and anti-hyperglycemic agents. There were also more drug-drug interactions in the medications prescribed compared to those with favorable outcomes. Together, these data suggest the need for enhanced screening of high-risk stroke survivors focused on close monitoring of polypharmacy, drug-drug interactions, and adverse events with pharmacotherapy.
      Citation: Journal of Pharmacy Practice
      PubDate: 2023-01-06T03:47:51Z
      DOI: 10.1177/08971900221150282
       
  • Impact of Clinical Pharmacist Practitioner Management of Chronic
           Obstructive Pulmonary Disease in the Ambulatory Care Setting

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      Authors: Alexa M. Haddon, Kylee R. Gross, Cassandra J. Mozes
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Objectives: To evaluate the impact of clinical pharmacist practitioner (CPP) management on potentially inappropriate use of inhaled corticosteroids (ICS) in the ambulatory care setting. Design: Multicenter, prospective quality assurance/improvement (QA/QI) project. Setting: Erie Veterans Affairs Medical Center (VAMC) and surrounding Ashtabula, Crawford, and Venango County Community-Based Outpatient Clinics (CBOCs). Participants: Thirty-five participants with chronic obstructive pulmonary disease (COPD) who met inclusion criteria were included in the project. Interventions: Participants were contacted to schedule an initial sixty-minute telephone visit with a CPP. Exacerbation history, rescue inhaler use, and symptom burden were assessed using the COPD Assessment Test (CAT) and Modified Medical Research Counsel Breathlessness Scale (mMRC) scales. Medication regimens were optimized based on guideline recommendations with an emphasis on appropriate use of ICS. Participants were scheduled for follow-up telephone visits with the CPP every 4 weeks. Main Outcome Measures: The primary project outcome was potentially inappropriate use of ICS without a long-acting muscarinic antagonist (LAMA)/long-acting beta agonist (LABA). Secondary project outcomes included ICS de-escalation, vaccinations, and smoking cessation. Results: The primary outcome of reducing use of ICS without a LAMA/LABA was achieved in thirty-one (88.6%) participants. ICS de-escalation was achieved in twenty-three (65.7%) participants. Rates of recommended vaccinations and smoking cessation with nicotine replacement therapy increased as a result of pharmacist intervention. Conclusion: Pharmacist management of COPD in the ambulatory care setting was associated with a decrease in potentially inappropriate use of ICS and an increase in preventative care measures.
      Citation: Journal of Pharmacy Practice
      PubDate: 2023-01-05T04:00:53Z
      DOI: 10.1177/08971900221150286
       
  • Access to Media and Emerging Technologies: An Evolving Opportunity for
           Pharmacists to Contribute to Improving Health Outcomes

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      Authors: Sharmon P. Osae, Daniel B. Chastain, Henry N. Young
      Abstract: Journal of Pharmacy Practice, Ahead of Print.

      Citation: Journal of Pharmacy Practice
      PubDate: 2023-01-05T01:56:39Z
      DOI: 10.1177/08971900221149159
       
  • The Impact of a Pharmacist-Driven Multicomponent Sleep-Promoting Protocol
           on Delirium in Critically Ill Patients

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      Authors: Dimitar Zelenkov, Randy Hollins, Eric J. Mahoney, Anthony J. Faugno, Janelle Poyant
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: Sleep deprivation is reported in 80% of patients in the intensive care unit (ICU) and is associated with delirium. Guidelines recommend implementing a sleep-promoting protocol in critically ill patients which may increase the quantity and quality of sleep and may decrease delirium. Our objective was to implement a pharmacist-led interdisciplinary sleep-promoting protocol and analyze its impact on delirium in ICU patients receiving mechanical ventilation (MV). Methods: The study involved pre-implementation education, protocol development, and post-implementation analysis. ICU pharmacists completed prospective patient chart reviews to reduce exposure to deliriogenic medications and assess the need for a pharmacologic sleep aid. The primary outcome was the incidence of delirium and delirium-free days. Secondary outcomes included ICU length of stay (LOS), incidence of MV, and pharmacist medication interventions. Results: Post-protocol patients (n = 185) had a higher incidence of delirium compared to pre-protocol patients (n = 237) (51.3% vs 39.0%; P = .01). Post-protocol patients had a higher average APACHE III score (P =
      Citation: Journal of Pharmacy Practice
      PubDate: 2023-01-03T08:26:54Z
      DOI: 10.1177/08971900221148581
       
  • Adverse Drug Reaction vs Care Complication: Response to “Use of
           Colony-Stimulating Factors in Patients With Systemic Lupus Erythematous”
           

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      Authors: Carolyn E. Ragsdale, Edwin P. Rock
      Abstract: Journal of Pharmacy Practice, Ahead of Print.

      Citation: Journal of Pharmacy Practice
      PubDate: 2023-01-02T09:46:40Z
      DOI: 10.1177/08971900221149549
       
  • Characterization of Medication Discrepancies and Interventions Resulting
           From Pharmacy-Led Medication Reconciliation in the Critical Care Setting

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      Authors: BrookeAnne Magrum, Keaton S. Smetana, Molly Thompson, Jessica L. Elefritz, Megan Phelps, Elizabeth Trolli, Claire V. Murphy
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundMedication reconciliation has been shown to reduce medication-related errors in hospitalized patients, but the impact of pharmacy-led medication reconciliation in the intensive care unit (ICU) has not been extensively studied.MethodsThis was a retrospective chart review of patients with a pharmacy-led medication reconciliation on admission to an ICU between January 1st and March 31st, 2018. Pharmacy-led medication reconciliations were completed by pharmacists, pharmacy residents, and pharmacy students. The objective of this study was to describe medication discrepancies identified by pharmacy-led medication reconciliation and to evaluate the interventions following.ResultsA total of 288 patients were screened and 247 met inclusion criteria. There were 1148 medication discrepancies identified resulting in an average of 4.65 discrepancies per patient. Medication addition (54.25%) and medication deletion (45.75%) were most common. Within 24 hours of medication reconciliation, 214 interventions were made to active orders. No differences were observed between discrepancies identified and type of pharmacy staff completing the medication reconciliation.ConclusionsThis study identified a high rate of medication discrepancies on admission to the ICU. Furthermore, it describes the types of pharmacist interventions following pharmacy-led medication reconciliation. This process may be impactful to incorporate as a standard practice in ICUs and warrants further investigation into value, cost, and pharmacist workflow.
      Citation: Journal of Pharmacy Practice
      PubDate: 2023-01-02T09:19:01Z
      DOI: 10.1177/08971900221149788
       
  • Assessing Pharmacist Interventions at an Outpatient Renal Transplant
           Clinic Under a Collaborative Pharmacy Practice Agreement

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      Authors: Rachel Chelewski, Keren Rodriguez, Megan Peter, Autumn Zuckerman
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: Collaborative pharmacist practice agreements (CPPAs) advance the role of pharmacists by granting prescriptive authority without direct oversight from participating physicians. Objective: To assess the quantity of prescriptions authorized by pharmacists and frequency and types of interventions performed under a CPPA in an outpatient renal transplant clinic. Practice description: Clinical pharmacists in the outpatient renal transplant clinic began prescribing medications under a CPPA in March 2017. Practice innovation: Under the CPPA, pharmacists perform interventions to improve medication management. After identifying gaps in medication therapy, pharmacists tracked their interventions to improve patient care. Methods: An ambispective cohort study evaluated the number of prescriptions and interventions performed under a CPPA. Patients with a prescription generated by pharmacists between January 2019 through June 2019 were included. Pharmacists prospectively collected the number and types of interventions performed; the number of pharmacist-generated prescriptions was retrospectively collected. Interventions were categorized into three groups: medical record assessments, medication counseling, and resolution of barriers to medication continuation. Results: Pharmacists under a CPPA placed 5793 prescriptions and performed 3852 interventions for 1233 patients. The most common intervention categories were medical record assessments, medication counseling, and resolution of barriers to medication continuation. Conclusion: Pharmacists within a CPPA performed medical record assessments to identify untreated or under treated health conditions, eliminate duplicate therapy, and monitor narrow therapeutic drugs. Expanding pharmacists’ prescriptive authority within the renal transplant clinic is a successful strategy to ensure patients are taking medications correctly and to avoid barriers to medication persistence.
      Citation: Journal of Pharmacy Practice
      PubDate: 2023-01-02T03:04:50Z
      DOI: 10.1177/08971900221149544
       
  • Community Pharmacist and Family Medicine Collaboration for Pre-Visit
           Planning for Shared Patients Receiving Chronic Care Management Services

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      Authors: James D. Hoehns, Matthew Witry, Madison McDonald, Sarah Kadura, Emily O’Brien, Robert Nichols, Joe Greenwood, Jamie Snyder, Raemi Chavez, Adam Froyum-Roise
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: Pre-visit planning entails completing necessary tasks prior to clinic appointments. Community pharmacists (CPs) have unique knowledge about patients’ medication use but do not routinely provide drug therapy reviews before clinic visits. Objectives: (1) Create and implement a business partnership between a CP and family medicine clinic (FMC) for CP provision of pre-visit medication reviews, and (2) describe the billing experience for shared patients in the FMC chronic care management (CCM) program. Methods: A prospective 8-month study in one community pharmacy and FMC in Iowa. Eligible patients were enrolled in the clinic CCM program and received their prescriptions at the CP. CPs were granted access to the clinic electronic health record (EHR), performed medication reviews, and recorded drug therapy recommendations (DTRs) in the clinic EHR. FMC physicians reviewed CP DTRs before the patient encounter. Time tracking software in the EHR recorded CP and FMC time performing CCM services. CCM revenue was prorated between parties. FMC physicians completed a survey about their experience. Results: Overall, there were 129 CP reviews performed for 95 patients. These reviews resulted in 169 DTRs and 76% were accepted by the physician. There were 71 CCM claims billed and CCM revenue was $3596 ($1796 FMC, $1800 CP). More than 90% of physicians (N = 11) indicated they reviewed CP DTRs before the patient encounter and agreed they were helpful to their practice. Conclusion: CPs completed pre-visit medication reviews and made accepted medication therapy recommendations. CCM billing provided a mechanism for CPs to receive revenue for their services.
      Citation: Journal of Pharmacy Practice
      PubDate: 2023-01-02T01:14:29Z
      DOI: 10.1177/08971900221148042
       
  • Pharmacists’ Perceptions of Mental Well-Being and Immunization
           Safety During COVID-19

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      Authors: Emily Peel, Chinelo C. Orji, Shelbie Ogan, Julie Gould, Gretta Leckbee, Carolyn M. Brown, Nathan Pope
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Purpose: To assess pharmacists’ mental well-being, perceptions of safety, and willingness to administer vaccines before and during the COVID-19 pandemic. Methods: An electronic survey was administered to a convenient sample of practicing pharmacists working in Alabama, Tennessee and Texas. The 33-item survey examined pharmacists’ beliefs about the pandemic’s impact on their mental well-being, their perceptions of safety in vaccine administration, and their willingness to vaccinate. Responses were assessed on a 5-point Likert scale, ranging from strongly disagree (1) to strongly agree (5). A recruitment email with the survey link was sent to pharmacists, with periodic reminders over a 4-week period. Descriptive statistics and bivariate analyses were utilized to evaluate survey responses. Results: A total of 387 responses were analyzed, with an estimated response rate of 3.93%. Most respondents were women (65%) and had at least 6 to 10 years of practice experience (28%). Overall, participants felt that the pandemic worsened their mental well-being, with women reporting a more negative mental well-being compared with men (P < .001). They reported having less time during workflow to apply personal protective equipment (PPE) (P = .0074) compared to before the pandemic. They also reported a decrease in willingness to vaccinate adult patients during the pandemic (P < .0001), and that concern about contracting COVID-19 prevented them from giving vaccinations (P < .0001). Conclusions: Pharmacists felt their mental well-being and willingness to vaccinate patients suffered as a result of the COVID-19 pandemic. Future research and initiatives that focus on improving vaccination rates should also consider pharmacists’ concerns and well-being.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-12-27T02:28:57Z
      DOI: 10.1177/08971900221149145
       
  • Hemostatic Efficacy and Safety of 4-Factor Prothrombin Complex Concentrate
           in Doac-Associated Intracranial Hemorrhage

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      Authors: Patrick M. Whaley, Crystal Franco-Martinez, Ashley E. Lock, Davana Ramaswamy, Eric H. Young, Stefan M. Allen, Colleen A. Barthol
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: Factor Xa (FXa) inhibitor use has increased over the last decade and though associated rates of major bleeding are lower compared to warfarin, outcomes from intracranial hemorrhage (ICH) are still significant. Targeted FXa inhibitor reversal agent became available in 2018, however use of 4-factor prothrombin complex concentrate (4F-PCC) for FXa inhibitor-associated ICH continues at many institutions. Objective: Evaluate the safety and hemostatic efficacy of 4F-PCC for FXa inhibitor-associated ICH. Methods: Single-center, retrospective study of patients who received 4F-PCC for FXa inhibitor-associated ICH. The primary efficacy endpoint was hemostasis and thrombosis was the main safety endpoint. Secondary endpoints included in-hospital mortality and discharge disposition. Results: 76 patients on apixaban or rivaroxaban were included. Good or excellent hemostasis was achieved in 80.3% of patients. Five patients experienced a thrombotic event. Favorable discharge disposition and lower in-hospital mortality was more likely in patients who achieved excellent hemostasis. Conclusion: 4F-PCC is safe and effective for FXa inhibitor associated ICH.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-12-24T05:28:26Z
      DOI: 10.1177/08971900221148034
       
  • A Case Report of Sudden Sensorineural Hearing Loss (SSNHL) After
           Administration of the COVID-19 Vaccine

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      Authors: Justin Andrade, Lauren Sessa, Moshe Ephrat, James Truong, Robert DiGregorio
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Since the issuance of the emergency use authorization (EUA) of 3 coronavirus disease 2019 (COVID-19) vaccines, there have been over 180 million individuals fully vaccinated in the United States (US). With the increasing administration of COVID-19 vaccinations, there have been over 550,000 adverse events reported in the Vaccine Adverse Event Reporting System (VAERS) with approximately 230,000 experienced after receipt of the Pfizer-BioNTech COVID-19 Vaccine as of September 23rd 2021. Audio-vestibular symptoms (including Sudden Sensorineural Hearing Loss (SSNHL)) secondary to immunizations has previously been evaluated. However, this report describes the first case of bilateral sudden sensorineural hearing loss potentially due to the Pfizer-BioNTech COVID-19 vaccine. We further review the available literature regarding the treatment of Sudden Sensorineural Hearing Loss, and the association of SSNHL with previous immunizations and COVID-19 infection. Lastly, we hypothesize the underlying potential mechanisms between SSNHL and the Pfizer-BioNTech COVID-19 vaccine.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-12-20T07:49:27Z
      DOI: 10.1177/08971900221147584
       
  • Assessment of Potentially Inappropriate Prescribing for People With Type 2
           Diabetes Mellitus Using IMPACT2DM, a New Explicit Tool

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      Authors: Mohammed B. Ayalew, Gudrun Dieberg, Frances Quirk, Marion J. Spark
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundPeople with type 2 diabetes mellitus (T2DM) are at greater risk of potentially inappropriate prescribing (PIP) due to multiple comorbidities and polypharmacy. IMPACT2DM (Inappropriate Medication Prescribing Assessment Criteria for Type 2 Diabetes Mellitus) is a tool designed to identify PIP for adults with T2DM.ObjectivesTo assess PIP for adults with T2DM in Ethiopia using the IMPACT2DM and to test the face validity and clinical validity of the tool.MethodsA cross-sectional study was undertaken using data extracted retrospectively from the medical records of adults being managed for T2DM at Debretabore Hospital. PIP was assessed using IMPACT2DM. Some items/item components of IMPACT2DM were modified to increase the tool’s applicability for the outpatient setting, to clarify content or to use the terms most common in this particular setting. Multivariant logistic regression analyses were conducted to identify factors associated with PIP.ResultsMore than 90% of medical records had at least 1 PIP. Prescribing omission (80.9%) was the most commonly identified type of PIP. Adults with prescribing omissions are more likely to be ≥40 years old or to be prescribed with 50 years.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-12-16T11:35:41Z
      DOI: 10.1177/08971900221145219
       
  • Comparison of Continuous Albumin Infusion, Bolus Albumin, and Crystalloid
           Fluid Administration in Open-Abdomen Surgical-Trauma Patients

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      Authors: Nathan T. Goad, Earnest Alexander, Christopher Allen, John Y. Cha
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: The open abdomen (OA), an intentional lack of fascial closure following abdominal cavity opening, is utilized for various indications among surgical-trauma patients. Among intravenous fluid options, administration of albumin as a continuous infusion may improve outcomes in OA. The purpose of this study is to compare the time to abdomen closure among patients with OA according to type of fluid administration. Methods: We conducted a retrospective cohort study of adults with OA from 2012 through 2018 and stratified by intravenous fluid administration into one of three groups: continuous albumin infusion, intermittent bolus albumin, or crystalloid. The primary outcome was median time to abdomen closure. Secondary outcomes included hemodynamic parameters, length of stay (LOS), and mortality. Time to final abdomen closure was analyzed by Cox proportional hazards regression. Results: Eighty-four patients were included with 28 in each cohort. Compared to crystalloids (44.2 [interquartile range, IQR, 36.3-62.9] hours), median time to abdomen closure was significantly longer in bolus albumin (79.0 [IQR, 44.5-130.8] hours; P = .002) and continuous albumin groups (63.6 [IQR, 42.9-139.6] hours; P = .001) in Cox regression analysis. The incidence of hospital mortality was highest in the bolus albumin cohort (continuous albumin: 21.4% vs bolus albumin: 50.0% vs crystalloid: 25.0%; P = .044). All other secondary outcomes were similar between groups. Conclusions: Among patients with OA, administration of intravenous crystalloid was associated with the shortest time to abdomen closure compared to bolus or continuous albumin. Further evaluation of continuous albumin infusion in patients with OA is needed.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-12-14T08:27:20Z
      DOI: 10.1177/08971900221145991
       
  • Apixaban-Associated Intracranial Hemorrhage in a Patient With Elevated
           International Normalized Ratio

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      Authors: Sophia Pathan, Andrew T. Genco
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Apixaban has been associated with prolongation of the international normalized ratio (INR), but data surrounding the extent of elevation and its clinical significance are limited. Due to interaction between apixaban and the prothrombin assay, elevations in INR in patients receiving apixaban are common and not always grounds for concern. However, in high risk patients, elevations can represent a need for closer monitoring. This case summarizes an 82-year-old woman with a history of atrial fibrillation and left middle cerebral artery strokes with no residual deficits. She presented with right-sided hemiparesis and aphasia and underwent a mechanical thrombectomy with TICI 2b recanalization of a left M1 occlusion. Post-thrombectomy, she was found to have a left atrial thrombus and 10 days later was started on apixaban 5 mg twice daily. On the fourth day of apixaban therapy, she experienced an INR increase to 2.3, prompting initiation of a vitamin K challenge for nutritional deficiency. Despite initial improvement, her INR increased to 2.7 a week after apixaban was initiated, coinciding with a decline in mental status and an apixaban peak level of 435.6 ng/mL (reference range 91-321 ng/mL). A computed tomography (CT) scan of her head showed new intracranial hemorrhage in the area of her previous infarction, prompting apixaban reversal with andexanet alfa. Unfortunately, the patient expired. This case report highlights the importance and difficulty in performing therapeutic drug monitoring in patients receiving oral anti-factor Xa inhibitors, revealing a downside to administration of high-risk medications that do not have readily available monitoring.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-12-09T10:05:17Z
      DOI: 10.1177/08971900221144125
       
  • Reduced-Dose Apixaban in the Treatment of Left Ventricular Thrombus: A
           Report of 2 Cases

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      Authors: Adrienne E. Bundrick, Riley D. Bowers, Scott L. Perkins, Carrie N. Baker
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      According to the American College of Cardiology and the American Heart Association, warfarin has historically been the standard of care anticoagulant for the treatment of left ventricular thrombus. The use of direct oral anticoagulants (DOACs) has become more prevalent, as they require less frequent laboratory monitoring, offer fixed-dose regimens, are associated with fewer drug-drug and drug-food interactions, and provide more favorable safety profiles when compared to warfarin. However, DOACs are not currently FDA-indicated in the treatment of left ventricular (LV) thrombus. Numerous recent studies have reported and evaluated the use of DOACs for treatment of LV thrombus. Recently, a prospective, open-label, multicenter study evaluated warfarin compared to DOACs for LV thrombus treatment. The AHA recently published a scientific statement regarding the management of patients at risk for and with left ventricular thrombus, which included DOACs as a reasonable alternative to warfarin. This report describes two patients treated with DOACs following LV thrombus diagnosis. The first case is a 71-year-old male admitted for cerebrovascular accident and non-ST-elevation myocardial infarction complicated by a LV thrombus. The second case is an 83-year-old female admitted for acute myocardial infarction complicated with an LV thrombus. Both patients were prescribed apixaban 2.5 mg twice daily. Neither patient has experienced LV thrombus or DOAC treatment related complications. This case series serves as evidence for reduced-dose DOACs as an alternative to warfarin in the treatment of LV thrombus.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-12-08T07:21:42Z
      DOI: 10.1177/08971900221145051
       
  • Impact of Implementing Screening and Interventions to Target Prevention of
           Opioid Misuse and Accidental Overdose in the Inpatient Setting

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      Authors: Siri Bjornson, Carlina J. Grindeland, Amy B. Werremeyer
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Introduction: There are limited publications supporting the use of screening tools to implement upstream prevention of opioid-related problems. Opioid and Naloxone Education (ONE) is utilized in outpatient pharmacies to screen and identify patients at risk of opioid-related problems and make interventions. Objectives: To implement ONE in the inpatient setting to promote prevention of opioid-related problems and overdose risk mitigation. Methods: For this pilot, ONE screening tool was completed via chart review and patient interview for inpatients prescribed an opioid. Risk scores were calculated and recommendations were provided. Outcomes evaluated included morphine milligram equivalents (MME) prior to hospitalization, inpatient screening pre-, post-, and at discharge; naloxone orders at discharge; and comparison of overdose risk from different sources. Results: The control group (n = 44) had a mean MME decrease of 1.5, and following implementation of pharmacist interventions, the experimental group (n = 45) observed a mean MME decrease of 28.6 (P = .0001). For the threshold of 50 MME, 8.6% of patients in the control group had a change from>50 MME to
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-12-06T05:12:25Z
      DOI: 10.1177/08971900221144183
       
  • Clinical Pharmacy Specialist Collaborative Management and Prescription of
           Diabetes Medications with Cardiovascular Benefit

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      Authors: Briana Ballister, Rebecca L. Hernandez, Lieth H. Quffa, Andrew J. Franck
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundInvolvement of Clinical Pharmacy Specialists (CPS) in the care of patients with diabetes mellitus (DM) has been demonstrated to be beneficial. Whether this positive impact applies to increased use of cardiovascular risk-reducing medications is less well established.ObjectiveTo determine the association of CPS co-management on the prescription of diabetes medications with proven cardiovascular benefits for patients with DM and established cardiovascular disease in the primary care setting.MethodsThis retrospective cohort study evaluated patients in a Veterans Affairs health-system in primary care settings from February 1, 2019, through January 31, 2020. Patients were included if they had type 2 DM treated with at least one medication and had CVD. Patients were grouped into two cohorts for comparison, those with CPS co-management and those without. The primary outcome was the proportion of patients in each group with new prescriptions for empagliflozin or liraglutide initiated during the study timeframe.ResultsIn total, 8058 patients were found eligible for inclusion in the study. Clinical co-management by a CPS was provided to 2099 patients. Study medications were prescribed, approved, and initiated in 596 patients during the study period, including 391 (18.6%) in the CPS group and 205 (3.4%) in the non-CPS group (P < .001).ConclusionThis study showed CPS involvement is associated with increased prescribing of diabetes medications with proven cardiovascular benefits.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-12-05T07:18:19Z
      DOI: 10.1177/08971900221144399
       
  • De-Prescribing Inhaled Corticosteroids in Chronic Obstructive Pulmonary
           Disease: A Narrative Review

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      Authors: Michelle N. Schroeder, Hailee M. Sens, Shaina K. Shah
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Objective: Combination therapy, including inhaled corticosteroids (ICS), is often prescribed as initial treatment for Chronic Obstructive Pulmonary Disease (COPD) despite limited evidence that ICS therapy is beneficial. Prescribing rates exceed the estimated number of candidates diagnosed with COPD who are eligible for ICS treatment per guideline-directed therapy. Therefore, some patients would benefit from ICS withdrawal due to potentially inappropriate prescribing. This review aims to highlight evidence evaluating ICS withdrawal approaches in COPD. Methods: A comprehensive literature review was performed between June 2021 and March 2022 with assistance from a reference librarian. Sources of literature review include PubMed and Embase. The authors selected randomized controlled trials and articles evaluating ICS withdrawal approaches in patients with COPD. Three clinical trials and one post-hoc analysis are discussed in this review. Pertinent safety, efficacy, and statistical and clinical outcomes are summarized. Conclusions: The most appropriate approach to de-prescribe ICS maintenance therapy in COPD without clear indication remains uncertain. Pharmacists can play a role in optimizing clinical outcomes by analyzing ICS use in practice and identifying potential candidates for ICS withdrawal. The withdrawal protocols discussed in this review offer options for clinicians to help guide therapy decisions.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-12-02T01:19:42Z
      DOI: 10.1177/08971900221144127
       
  • Meta-Analysis Comparing Bivalirudin Versus. Unfractionated Heparin in
           Adult Patients With Extracorporeal Membrane Oxygenation

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      Authors: Kazuhiko Kido, Galen M. Kabulski, Thomas W. Szymanski, Tsuyoshi Shiga, Mikiko Shimizu, Masayuki Hashiguchi
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Introduction: Unfractionated heparin (UFH) has traditionally been the agent of choice in patients on extracorporeal membrane oxygenation (ECMO). However, direct thrombin inhibitors (DTI) have recently garnered more attention in ECMO because of their advantages over UFH. Given the heterogeneous results of multiple recent published studies, we performed a meta-analysis to describe pooled outcomes between bivalirudin and UFH anticoagulation in patients on ECMO. Methods: Relevant studies were identified from MEDLINE and Google Scholar database searches through April 23, 2022. The primary efficacy outcome was thromboembolism (TE), and secondary efficacy outcomes included all-cause mortality and circuit thrombosis. The primary safety outcome was major bleeding. Results: A total of 6 studies were included in the meta-analysis. Bivalirudin use was associated with significantly lower risk of TE (OR 0.61; 95% CI 0.38-.99; P = .05; I2 = 0%) and circuit thrombosis (OR 0.51; 95% CI .32-.80; P = .004; I2 = 0%) compared with UFH. There was no significant difference in all-cause mortality risk (OR 0.75; 95% CI .52−1.09; P = .13; I2 = 30%) between the bivalirudin and UFH groups. No significant difference in the risk of major bleeding between 2 groups was found (OR 0.67; 95% CI 0.25−1.81; P = .43; I2 = 80%). Conclusion: These data support that bivalirudin is a reasonable alternative to UFH in patients on ECMO. Randomized controlled trials are needed to confirm bivalirudin’s efficacy and safety results compared with UFH.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-11-30T05:51:28Z
      DOI: 10.1177/08971900221143406
       
  • Healthcare Equity and Leadership: Implementation of Diversity, Equity, and
           Inclusion Training for Pharmacy Residents

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      Authors: Frank Tillman, Ina Liu, Judith Lovince, Erin Mays, Kaitlin Musick, Jennifer Sato, Kamakshi V. Rao
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundPharmacy training programs infrequently include formal training in the areas of diversity, equity, and inclusion (DEI). Hence, the purpose of this report is to offer perspectives gained from the delivery of a DEI curriculum within a pharmacy residency program aimed at expanding experiential learning focused on DEI and health equity. Program Implementation: Pharmacy residents at an academic medical center were invited to participate in a longitudinal DEI/equity seminar series that was thoughtfully and strategically developed by a team of residents and program leadership based on a six-step process. Residents were offered 9 individual seminars covering 4 major focus areas to facilitate enhanced awareness, learning, and vulnerability. Participants were invited to provide evaluations of each seminar and the overall series. Program Assessment: A total of 41 residents (100%) participated in at least one of the 9 seminars that were offered and approximately 50% completed the post-series survey. Resident-perceived benefit of each individual session was consistently favorable. Additionally, greater than 70% of participants responded favorably when asked about the impact of each session on their awareness, resources provided, and ability to apply the learnings to their practice. Conclusion: Our inaugural experience with the integration of a DEI seminar series into a pharmacy residency program suggests that there is a clear benefit to including DEI/health equity into pharmacy residency training. This data may suggest that adoption of DEI-focused experiential training may increase cultural awareness and the availability of resources to better equip pharmacy residents in applying concepts of DEI into their practice.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-11-30T03:35:48Z
      DOI: 10.1177/08971900221142684
       
  • Severe Hypotension With Concomitant Sodium-Glucose Co-Transporter-2
           Inhibitor and Angiotensin Receptor-Neprilysin Inhibitor Therapy in a
           Patient With Heart Failure Reduced Ejection Fraction: A Case Report

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      Authors: Christine Schumacher
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: Large cardiovascular outcomes trials in individuals with heart failure, with and without diabetes, have demonstrated a significant risk reduction in the composite outcome of cardiovascular death or hospitalizations for heart failure with SGLT2 inhibitor therapy. These positive outcomes have led to the recommendation that SGLT2 inhibitors serve as backbone therapy in patients with heart failure reduced ejection fraction (HFrEF). To date, there has not been enough participants in clinical trials on concomitant SGLT2 inhibitor and angiotensin receptor-neprilysin inhibitor therapy to evaluate the benefits and risks of combination therapy with these two agents outside of smaller subgroup analyses. Case Summary: This case describes a Black female with diabetes meeting her glycemic targets and concomitant stable NYHA FC II HFrEF on guideline-directed medical therapy (GDMT) with sacubitril/valsartan, spironolactone and metoprolol succinate who developed severe hypotension and dehydration requiring hospitalization after initiation of SGLT2 inhibitor therapy. Practice Implications: This case report raises the question of whether those with type 2 diabetes, and/or those on background angiotensin receptor-neprilysin inhibitor therapy, who are euvolemic or sensitive to diuretic therapy should be started on lower dose dapagliflozin and titrated to 10 mg daily based on response. It also raises awareness to the potential increased diuretic effect produced with concomitant use of sacubitril/valsartan and dapagliflozin. Caution and education to mitigate the risk for volume depletion should be provided to those patients who are euvolemic and initiated on a SGLT2 inhibitor, regardless of their background diuretic and GDMT. Conclusion: Future research should focus on the benefits and safety considerations and provide education on how to best initiate and adjust SGLT2 inhibitors in the setting of sacubitril/valsartan use in diverse heart failure patient populations.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-11-28T08:21:24Z
      DOI: 10.1177/08971900221142686
       
  • Peripartum Pharmacotherapy: A Pharmacist’s Guide

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      Authors: Kylie N. Barnes, Lauren D. Leader, Nicole E. Cieri-Hutcherson, Julie Kelsey, Mary F. Hebert, Lamis R. Karaoui, Sarah McBane
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Complications throughout the peripartum period may be caused by preexisting conditions or pregnancy-induced conditions and may alter pharmacotherapy management. Pharmacotherapy management during late pregnancy and delivery requires careful consideration due to changing hormones, hemodynamic status, and pharmacokinetics, and concerns for potential maternal and/or fetal morbidity. Increased maternal and fetal monitoring are often required and may lead to therapy changes. Pharmacists, as key members of the interprofessional team, can contribute essential perspective to the management of postpartum pharmacotherapy through assessment and recommendation of appropriate and judicious use of medications.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-11-25T04:33:28Z
      DOI: 10.1177/08971900221142681
       
  • Changes in Opioid Prescription Rates at Discharge After Targeted Provider
           Education in the Emergency Department

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      Authors: Deborah Booth, Christopher Amalfitano, Anthony Forestine
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      IntroductionOpioid-related mortality continues to increase in the United States and emergency departments (ED) are a source of opioid prescribing. A review was conducted of prescribing practices and all prescribers were given targeted education to modify prescribing patterns and facilitate guideline recommended opioid prescribing. This study seeks to evaluate prescribing practices after implementation of the education that occurred December 23 to 31, 2019 on prescribing habits. The pre-education group was defined as the period of January 1, 2019 to December 31, 2019. The post-education group was defined as the period of January 1, 2020 to December 31, 2020.ObjectiveEvaluate the total number of prescriptions and prescription doses in morphine milligram equivalent (MME) prescribed between pre-education and post-education groups. Secondary endpoints will be an evaluation of the number of doses, length of therapy, and the rates of prescribing per 100 discharges.MethodsA retrospective chart review at a single center suburban ED was conducted comparing prescribing after education was provided. Patients were excluded if they were under the age of 18 years, admitted or transferred to an acute care facility, or prescribed an opioid for a non-analgesic purpose.ResultsThere was a 34% reduction in the total number of opioid prescriptions from the pre-education group compared to the post-education group (4,253 to 2,818). Between the 2 groups, there was a reduction in MME of 8.8 (92.2 ± 60.4 vs 83.4 ± 60), P < 0.001, number of tablets by 0.9 tablets (13.6 ± 5.2 vs 12.7 ± 5.4), P < 0.001, and day supply by 0.12 (4.45 ± 2.1 vs 4.33 ± 2.0), P = 0.017. Percentage of the total number of opioid prescriptions per 100 discharges decreased by 0.4% from 5.1% to 4.7%.ConclusionAfter targeting providers through education, a reduction in opioid prescribing was identified through all endpoints.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-11-14T04:58:13Z
      DOI: 10.1177/08971900221131911
       
  • Alogliptin and Heart Failure Outcomes in Patients With Type 2 Diabetes

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      Authors: Sara N. Layman, Whitney V. Elliott, Daniel W. Neu, Tiffany G. Howard, Aaron Hamby
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: In 2016, the FDA issued a warning for saxagliptin and alogliptin regarding an increased risk of heart failure (HF), potentially limiting the use of effective medications in type 2 diabetes. Current data and guideline recommendations regarding HF risk are conflicting, especially with alogliptin. In March 2019, the Memphis Veterans Affairs Medical Center made a formulary change from saxagliptin to alogliptin, creating an opportunity to evaluate a large number of patients receiving alogliptin. Objective: To evaluate the risk of HF with alogliptin use in type 2 diabetes patients. Methods: A retrospective chart review of patients prescribed alogliptin was performed. The primary outcome was the composite number of HF hospital admissions and ED visits. Secondary outcomes included exacerbation rates among established HF patients, incidence of new-onset HF, incidence of alogliptin discontinuation due to HF, comparison of HF exacerbations between saxagliptin and alogliptin in patients with prior saxagliptin use, and evaluation of concomitant cardiotoxic medications. Results: 455 patients were included. A composite of 28 hospital admissions and ED visits occurred for a HF exacerbation. Fourteen patients (26.4%) of 53 patients with established HF had an exacerbation, whereas 5 patients (1.2%) of 402 patients with no history of HF had an exacerbation. Eight patients (2%) developed new-onset HF. Alogliptin was discontinued in 4 patients (0.9%) due to HF. No statistically significant difference in HF exacerbations was found between patients on alogliptin who previously received saxagliptin (4.8% vs 4.2%, P = 0.726). Conclusions: Alogliptin may increase the risk of HF exacerbation in patients with established HF.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-11-11T06:05:35Z
      DOI: 10.1177/08971900221135656
       
  • Pharmacist-Managed Diabetic Retinopathy in Hispanic/LatinX Population

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      Authors: Janvi Patel, Jasmine D Gonzalvo, George J Eckert, Andrew N Schmelz, Ashay D Bhatwadekar
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      There are three major microvascular complications of diabetes, retinopathy, nephropathy, and neuropathy, among which diabetic retinopathy (DR) is the most common. Several studies suggest that the Hispanic/LatinX population exhibit the highest cases of both diabetes and DR. Strategies aimed at reducing risk factors that could minimize the likelihood of DR development or progression could be beneficial. This retrospective study assessed DR in the Hispanic/LatinX population in pharmacist-managed cardiovascular risk reduction services. A chart review was conducted for 60 individuals who visited clinics led by both a pharmacist and a primary care physician (intervention group) and 178 individuals who saw physicians only (control group). Demographics, metabolic parameters, DR severity, and pharmacist appointment data were collected. The highest benefit of pharmacist intervention was observed in terms of a greater but insignificant decrease in HbA1c; however, there was no benefit of pharmacist’s intervention on DR in general, likely due to the longer duration of diabetes and higher HbA1c at the beginning of the study. When the DR progression was examined based on the frequency of pharmacy visits, individuals who met a pharmacist more than two times per year showed more stable and lesser worsening of DR. Overall, our studies suggest that pharmacist intervention could benefit retinopathy outcome; however, well-known determinants of DR such as good glycemic control and duration of diabetes still play a critical role, in addition to challenges in receiving healthcare by the Hispanic/LatinX population. Future strategies in a prospective manner could help retinopathy outcomes in these at-risk patient populations.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-11-03T07:21:57Z
      DOI: 10.1177/08971900221136897
       
  • Factors Associated With PIM use in the Frail Elderly: A Cross-sectional
           Study

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      Authors: Camilla da P. Tranhago, Luana L. Colatto, Brígida D. Fernandes, Alexandra S. do C. Teixeira, André de O. Baldoni, Lorena R. Ayres, Daniela A. M. G. do Bem
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: The use of potentially inappropriate medications (PIM) by the elderly is commonly studied, but studies evaluating the use of PIM by frail elderly covered by prepaid health plans are still lacking. Objective: To identify the prevalence of use and the factors associated with the use of PIM by the elderly patients with high and moderate risk of clinical-functional vulnerability, according to the Beers criteria 2019. Methods: A cross-sectional study was developed with elderly people from a private health plan in Vitória-ES, Brazil. Socioeconomic, demographic and clinical data were collected through a digital platform and a structured questionnaire through an interview, from October 2018 to June 2019. The association between the use of PIM and independent variables was verified by univariate logistic regression with their respective confidence intervals (CI) 95%. The Multiple Model included the variables with P ≤ .20. Results: 332 elderly patients were interviewed (mean age 81.5 years, gender 237 female, 95 male). A 65% prevalence of PIM use was identified. In the multiple logistic regression model, the variables associated with the use of PIM were self-medication (P = .004), high risk of clinical-functional vulnerability (P = .022), use of psychotropic medications (P = .000001), musculoskeletal medications (P = .04) and alimentary tract medications (P = .03). Physical exercises were considered a protection factor (P = .02). Conclusion: The high prevalence of PIM use indicates the need for improvement in elderly private health care, to increase pharmacotherapy safety for this population.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-11-02T05:30:21Z
      DOI: 10.1177/08971900221137629
       
  • Time to Burn' Characteristics of Hydroxocobalamin Administration in an
           Academic Medical Center

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      Authors: Edric Wong, Nicholas Dodson, Sam Wagner, Stephen Thornton
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background/Objective: Hydroxocobalamin is indicated for cyanide poisoning and its package insert states it should be given “without delay”. We sought to evaluate time to administration and clinical characteristics when hydroxocobalamin was administered in a quaternary care academic medical center. Methods: All hydroxocobalamin administrations from January 1, 2007 to December 31, 2018 were analyzed. Data points recorded were: carboxyhemoglobin, cyanide and methemoglobin levels, hospital time and course, time and dose of hydroxocobalamin administration, lactate and bicarbonate levels, initial and nadir pH, initial heart rate, and initial and lowest systolic blood pressure. Results: Fifty-six cases were identified. One case was excluded as hydroxocobalamin was administered for nitroprusside toxicity. Among 55 cases analyzed, 93% (n = 51) were adults. Median hospital length of stay was 4.3 days (IQR 2.5 to 12). Burn, inhalation injury, and smoke inhalation were 80% of admitting diagnoses. Median time to hydroxocobalamin administration was 208 minutes (IQR 62.5 to 330). Eleven of 55 cases died. Hydroxocobalamin was given within 60 minutes of arrival in 12 cases, of which 3 died. All adults received 5 g of hydroxocobalamin. Time to hydroxocobalamin administration was longer in death cases [median: 221 minutes (IQR 119 to 594)] vs survivors [median: 184.5 minutes (IQR 62.8 to 315)]. Seventeen cases had cyanide levels drawn, with 9 being measurable, but none were toxic. Conclusions: Significant delay in hydroxocobalamin administration was seen in this study. Cases that resulted in death had significantly longer times to hydroxocobalamin administration. Further studies are warranted to identify reasons for delays in hydroxocobalamin administration.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-11-01T02:29:52Z
      DOI: 10.1177/08971900221136633
       
  • Angiotensin II Use in Treatment of Refractory Shock Due to Benazepril and
           Amlodipine Toxic Ingestion

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      Authors: G. Christina Gutierrez, Christopher Dayton, Rebecca L. Attridge, Lucas Smedley, Haritha Saikumar, Christopher Everett, Abraham Rodriguez, Shawn Varney
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      IntroductionCalcium channel blockers (CCB) are a leading cause of ingestion-associated fatality. Angiotensin-converting enzyme inhibitor (ACEi) overdose as part of co-ingestion is common and associated with refractory shock. Treatment options to manage this profound vasoplegia are limited. We describe the first case of use of newly formulated Angiotensin II for treatment of severe ACEi and CCB poisoning.Case ReportA 57-year-old man presented after suicide attempt by ingesting 20 tablets each of amlodipine 10 mg and benazepril 20 mg. His hypotension was initially managed with 35 mL/kg of crystalloid, norepinephrine, and hyperinsulinemic euglycemic therapy (HIET). His hemodynamics further deteriorated, and he developed lactic acidosis, electrolyte derangements, and renal dysfunction. Further complications of his ingestion included cardiac arrest, subsequent requirement for emergency cricothyrotomy, and renal replacement therapy. Maximal hemodynamic support with HIET therapy insulin drip 4.4 units/kg/hour, norepinephrine 2 mcg/kg/min, epinephrine 1 mcg/kg/min, vasopressin .06 units/hour, and intravenous lipid emulsion was unsuccessful. Ang II was started and titrated to maximal doses with dramatic improvement in hemodynamics. Within hours of starting Ang II, epinephrine was stopped and norepinephrine decreased by 50%. He was downgraded from the intensive care unit without any ongoing end-organ dysfunction.DiscussionIsolated CCB overdoses have high complication rates and well-established treatments. Therefore, management of CCB and ACEi co-ingestion is typically driven by CCB poisoning algorithm. There are multiple reports of CCB and ACEi co-ingestions causing treatment-refractory shock. Therapeutic options are limited by toxicities and availability of salvage therapies. Ang II is a safe and highly effective option to manage these patients.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-10-31T12:34:25Z
      DOI: 10.1177/08971900221137389
       
  • The Effect of Pharmacy-Led Medication Reconciliation on Odds of
           Psychiatric Relapse at a Community Hospital

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      Authors: Jamie Light, Christine Ruh, Michael Ott, Christopher Banker, Drake Meaney, Fred Doloresco, Katia Noyes
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Purpose: Individuals with psychiatric disorders are at increased risk for treatment non-adherence and related complications, especially during transitions of care. Medication reconciliation is now a standard process during hospital admissions that is uniformly recommended by international organizations to aid in safe and effective care transitions. Pharmacy-led medication reconciliation (PMR) practices are poised to represent a standardized method of reconciliation attempt within this underserved population with complex medication histories. Methods: A retrospective cross-sectional study using medical chart review was conducted for all adults admitted to the inpatient psychiatric service at a community hospital in Buffalo, NY, during 2 months in 2018. Outcomes were 30- and 180-day psychiatric readmission rates, 30- and 180-day visit rates to the outpatient comprehensive psychiatric emergency program (CPEP), and composite 30- and 180-day relapse. Receipt of pharmacy-led medication reconciliation was identified from pharmacy documentation in the electronic medical record. Results: 78% of patient’s medication lists on admission were reconciled, with 49% of reconciliations made by the inpatient pharmacy. Presence of a PMR did not alter the odds of inpatient readmission alone, however patients without a PMR were found to have 2.13 times higher odds of visiting the hospital’s outpatient CPEP within 30-days (P = .012) and 1.9 times higher odds of any composite psychiatric relapse within 30-days (P = .024). Conclusions: Implementation of hospital-wide pharmacy-led medication reconciliation on admission may help reduce psychiatric relapse across multiple care settings.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-10-31T11:23:29Z
      DOI: 10.1177/08971900221137100
       
  • Controlling Blood Pressure During a Pandemic: The Impact of Telepharmacy
           for Primary Care Patients

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      Authors: Bailey E. Bruns, Shirley A. Lorenzo-Castro, Genevieve M. Hale
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      IntroductionStudies have shown positive clinical outcomes in chronic conditions, such as hypertension, through pharmacist-delivered medication therapy management and medication adherence services. Given the need for social distancing during the COVID-19 pandemic, increased utilization of telepharmacy strategies has been employed for managing blood pressure control.MethodsA retrospective single-center cohort study that compared in-person pharmacist visits and telepharmacy visits in primary care patients with hypertension via electronic chart review from January 2018 to July 2022. Subjects were included who were at least 18 years of age with hypertension. Comparator groups were patients who underwent an in-person pharmacy (pre-COVID-19) visit vs a telepharmacy visit (post-COVID-19). The primary outcome was the number of patients with controlled blood pressure based on a blood pressure goal of less than or equal to 130/80 following telepharmacy visit vs in-person visit. Medication adherence, pharmacist intervention, incidence of antihypertensive side-effects, and blood pressure maintenance based on a goal of ≤140/90 were also evaluated.ResultsA total of 77 patients were included. There was no difference in the primary outcome following in person pharmacy visits compared to telepharmacy visits (P = .690). There was also no difference found for the secondary endpoints of blood pressure goal less than or equal to 140/90 mmHg (P = .481), medication adherence (P = 1.00), or antihypertensive adverse events (P = .344).ConclusionTelepharmacy visits had a nonsignificant change in blood pressure control when compared to in-person visits. Results suggest that the utilization of either in-person or telepharmacy strategies benefit the management of hypertension.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-10-27T07:28:15Z
      DOI: 10.1177/08971900221136629
       
  • Pharmacy and Physician Assistant Dual Degree: An Analysis of Its Value and
           Implications on the Profession

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      Authors: Yen H. Dang, Gregory K. Shaeffer, Robert Freeman, T. Sean Vasaitis
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      The pharmacy and physician assistant dual degree is one of the newest programs offered and has been predicted to have a high likelihood of growth in the future. With only an additional year of education, the PharmD-PA dual degree holder will have prescriptive authority upon graduation to expand their clinical roles. Additionally, by combining both medical and pharmacotherapeutics education, these mid-level practitioners could potentially improve healthcare shortages and allow for improvements in patient care. While there are established PharmD-PA dual degree programs, there is low enrollment coupled by rigorous curriculums and financial burdens that students must endure. Despite its limitations, this novel dual degree program offers pharmacy students another method to provide clinical care apart from the post-graduate opportunities. Schools of Pharmacy should look into the development of PharmD-PA dual degree programs as a unique marketing opportunity for admissions and as a non-traditional method of career advancement.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-10-25T07:02:00Z
      DOI: 10.1177/08971900221136636
       
  • Ketamine in Critically Ill Patients: Use, Perceptions, and Potential
           Barriers

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      Authors: Carolyn M. Bell, Megan A. Rech, Kwame A. Akuamoah-Boateng, George Kasotakis, Jeffrey D. McMurray, Benjamin A. Moses, Scott W. Mueller, Gourang P. Patel, Russel J. Roberts, Ankit Sakhuja, Ann Salvator, Erika L. Setliff, Christopher A. Droege
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Objective: To evaluate practitioner use of ketamine and identify potential barriers to use in acutely and critically ill patients. To compare characteristics, beliefs, and practices of ketamine frequent users and non-users. Methods: An online survey developed by members of the Society of Critical Care Medicine (SCCM) Clinical Pharmacy and Pharmacology Section was distributed to physician, pharmacist, nurse practitioner, physician assistant and nurse members of SCCM. The online survey queried SCCM members on self-reported practices regarding ketamine use and potential barriers in acute and critically ill patients. Results: Respondents, 341 analyzed, were mostly adult physicians, practicing in the United States at academic medical centers. Clinicians were comfortable or very comfortable using ketamine to facilitate intubation (80.0%), for analgesia (77.9%), procedural sedation (79.4%), continuous ICU sedation (65.8%), dressing changes (62.4%), or for asthma exacerbation and status epilepticus (58.8% and 40.4%). Clinicians were least comfortable with ketamine use for alcohol withdrawal and opioid detoxification (24.7% and 23.2%). Most respondents reported “never” or “infrequently” using ketamine preferentially for continuous IV analgesia (55.6%) or sedation (61%). Responses were mixed across dosing ranges and duration. The most common barriers to ketamine use were adverse effects (42.6%), other practitioners not routinely using the medication (41.5%), lack of evidence (33.5%), lack of familiarity (33.1%), and hospital/institutional policy guiding the indication for use (32.3%). Conclusion: Although most critical care practitioners report feeling comfortable using ketamine, there are many inconsistencies in practice regarding dose, duration, and reasons to avoid or limit ketamine use. Further educational tools may be targeted at practitioners to improve appropriate ketamine use.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-10-25T05:39:04Z
      DOI: 10.1177/08971900221134551
       
  • Deviations From Best Practice: Findings From a Certified Patient Safety
           Organization Remote-Verification Observational Study of Intravenous
           Compounding of Chemotherapeutic and Ancillary Drugs

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      Authors: Jeffrey Lombardo, John Coles, Daniel Ryszka, Christine Roussel, William Smith
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundChemotherapeutic and immunomodulatory medications can pose a serious risk to patient and healthcare provider safety because of complex processes, cytotoxicity, and prevalent medication use. Objective To evaluate chemotherapeutic and ancillary medication compounding in hospital pharmacies using a remote verification system, focusing on pharmaceutical deviations from best practice, compounding time, medication waste, and cost. Methods This retrospective, blinded observational study used a remote intravenous (IV) workflow verification system to examine IV chemotherapeutic compounding errors in large hospital systems. A Patient Safety Organization securely obtained>5000 compounding records and photos from the IV workflow system. Blinded pharmacists evaluated IV chemotherapy preparations using picture slide viewers to assess any deviations from best practice. Time variables, medication waste, STAT vs non-STAT orders, and cost were also evaluated. Results The most frequently reported deviations from best practice included medications exceeding the>10% additive volume guideline (35.9%) and inaccurate dose labels (28.3%). Time flow analyses demonstrated a substantial increase in total compounding time per vial for 1 vs 2 vials. Most medications in this analysis had an average waste ranging from 0-.36 vials. STAT orders, accounting for 38.4% of all orders, wasted more medication than non-STAT orders. Gemcitabine cost analyses showed an association for number of vials and compounding time with overall cost per dose. Conclusion Substantial inconsistencies between workflow stations were observed—highlighting the lack of standardization across chemotherapeutics, volume of medication waste during preparation, and the need to establish improved quality controls to safeguard patient and health care provider safety.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-10-22T05:38:08Z
      DOI: 10.1177/08971900221134836
       
  • Patterns of Lipid Lowering Therapy Use Among Older Adults in a Managed
           Care Advantage Plan in the United States

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      Authors: Aisha Vadhariya, Manvi Sharma, Susan M. Abughosh, Kim K. Birtcher, Hua Chen, Anjana Mohan, Michael L. Johnson
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: The prevalence of cardiovascular events is increasing. There are many new lipids lowering therapies available in recent years. Increased evidence through literature and guidelines suggests that the use of lipid lowering therapy (LLT) benefits patients who are at risk for cardiovascular events.Objective: The objective of this study was to describe the current LLT use as well as patterns of treatment modification among adults ≥ 65 years.Methods: A retrospective analysis of administrative claims data between January 2016 and May 2018 was conducted. Patients with a LLT refill and continuous enrollment during 1-year prior and 1-year follow-up were identified. The treatment episodes captured were interruption of therapy, intensity changes, dose changes, treatment augmentation, switching, and discontinuation. An analysis of treatment patterns among patients ≥75 years was also performed.Results: The study included 14,360 patients with a LLT of which 99% of patients were on statins as monotherapy or combination. Overall non-statin therapy use either as monotherapy or combination was 2.1%. There were significant differences among new initiators and existing users of therapy. Among prevalent users 57.4% had no changes in the follow-up period, 13.6% interrupted therapy, and 6.6% discontinued. Among new users, 47.9% patients had interrupted therapy, 25% had no changes, and 21.9% discontinued therapy.Conclusion: Most patients were on monotherapy and statins with low non-statin use. The new users among them were more likely to discontinue and interrupt therapy, highlighting the limitations and issues that older patients face that need to increase adherence.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-10-21T10:21:58Z
      DOI: 10.1177/08971900221128850
       
  • The Role of an Infectious Diseases Faculty Pharmacist and Pharmacy
           Students on an Antimicrobial Stewardship Team at a Community Non-teaching
           Hospital

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      Authors: Jaclyn A. Cusumano, Anna Defrank, Olivia G. Funk, Polina Lerner, Manisa Tanprayoon, Chirag Vasa, Dana Mazo
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: Antimicrobial stewardship program implementation at non-teaching community hospitals differs due to staffing and resource disparities. Objective: Demonstrate that an infectious disease (ID) pharmacist faculty with advanced pharmacy practice experience (APPE) students can expand antimicrobial stewardship services at non-teaching community hospitals. Methods: A single-center, retrospective chart review was conducted comparing prospective audit and feedback antimicrobial stewardship interventions by an ID pharmacist faculty with and without APPE students between January 16, 2020 to January 16, 2021. The primary endpoints were intervention rate and the intervention acceptance rate. Secondary endpoints included: the difference in the time from antimicrobial order to intervention and length of stay, as well as comparison of acceptance rates stratified by intervention type or the antimicrobial intervened upon. Results: A total of 739 antimicrobial stewardship interventions were made with an overall acceptance rate of 55.2%. The ID pharmacist faculty with APPE students had a higher number of interventions and intervention rate per working day compared to without students (428 vs 311 and 4.46 vs 2.99, respectively). Conversely, the intervention acceptance rate was lower for the ID pharmacist faculty with APPE students vs without (48.8% vs 64%, P < .001). Both the median time from antimicrobial order to the intervention and length of stay was lower for the ID pharmacist faculty with students vs without (2.50 days [interquartile range (IQR) 1.24 - 4.01] vs 2.99 days [IQR 1.64 - 4.95], P = .003, and 9.20 days [IQR 5.57 - 14.93] vs 11.69 days [IQR 6.89 - 22.31], P < .001, respectively). The acceptance rates by intervention type and the antimicrobial intervened upon were similar between groups. Conclusion: An ID pharmacist faculty with APPE students at a non-teaching community hospital increased the number of stewardship interventions, and was associated with decreased time from antimicrobial order to intervention and length of stay.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-10-20T06:58:43Z
      DOI: 10.1177/08971900221134648
       
  • Characterization of Opioid Use in the Intensive Care Unit and Its Impact
           Across Care Transitions: A Prospective Study

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      Authors: Christian D. Hauser, Carolyn M. Bell, R. Amanda Zamora, Joseph Mazur, Ron R. Neyens
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      PurposeThe objective of this study is to characterize opioid intensity in the intensive care unit (ICU) and its association with opioid utilization across care transitions.MethodsThis is a prospective cohort study. Medically ill ICU patients with complete medication histories who survived to discharge were included. Opioid intensity was characterized based on IV morphine milligram equivalents (IV MME). Primary outcomes were opioid prescribing upon ICU and hospital discharge.ResultsOpioids were prescribed to 34.1% and 31.1% of patients upon ICU and hospital discharge. Within the ≥50 mean IV MME/ICU day cohort, 64.7% of patients received opioids after ICU discharge compared to 45.8% and 13.6% in the 1-49 mean IV MME/ICU day and no opioid groups (P < .05). Within the ≥50 mean IV MME/ICU day cohort, 70.6% of patients were prescribed opioids after hospitalization compared to 37.3% and 13.6% of patients who received less or no opioids. (P < .05). Within the ≥50 mean IV MME/ICU day cohort, 29.4% of patients were opioid naïve and discharged with an opioid, which is over double compared to patients with lower opioid requirements (P < .05).ConclusionPatients with higher mean daily ICU opioid requirements had increased opioid prescribing across care transitions despite preadmission opioid use.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-10-19T10:43:42Z
      DOI: 10.1177/08971900221134553
       
  • Viewpoints of Residency Program Directors Regarding Depressive Symptoms in
           Pharmacy Residents

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      Authors: Kaylee Putney, Vasudha Gupta, Evan Williams, Elizabeth Unni
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Objective: Several publications have highlighted residency-specific factors being associated with depressive symptoms in pharmacy residents, but no studies have investigated the viewpoint of residency program directors (RPDs) regarding this issue. This study’s primary objectives were to identify potential contributing factors, determine current resources, and outline possible solutions to decrease depressive symptoms among pharmacy residents from the point of view of RPDs. Methods: RPDs were asked to participate in a 45-60-minute semi-structured interview conducted via phone by the primary investigator, recorded, and transcribed using NVivo. Interviews were manually analyzed by study investigators to identify emerging themes. The investigators discussed findings and discrepancies to agree upon thematic interpretations of the transcripts. Results: Ten interviews were conducted between May 2019 and February 2020. RPD experience ranged from 2-15 years. Pharmacy practice PGY1 programs comprised 60% of interviews, 20% for community practice, and 10% each for managed care and ambulatory care. All RPDs indicated increased workload as a contributing factor to depressive symptoms in residents. The inability to accept and utilize constructive feedback and difficulties transitioning from student to resident were identified as contributing factors by 50% of the RPDs. Nine RPDs reported having employee assistance programs, stating the resource was underutilized, and identified the need for additional education regarding identification and triage, not necessarily management, to help residents. Conclusion: This study highlights consistency among RPDs regarding potential contributors to depressive symptoms in pharmacy residents and emphasizes the need for additional RPD and preceptor training to identify and help residents more effectively with these issues.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-10-17T03:23:48Z
      DOI: 10.1177/08971900221134647
       
  • Multicenter Resident Research – Let’s Go

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      Authors: Michael L. Behal, Aaron M. Cook
      Abstract: Journal of Pharmacy Practice, Ahead of Print.

      Citation: Journal of Pharmacy Practice
      PubDate: 2022-10-15T12:37:40Z
      DOI: 10.1177/08971900221134649
       
  • Assessing Community Pharmacists’ Perception on Readiness to Initiate
           Point-of-Care Testing for SARS-CoV-2 in New York State During the Pandemic
           

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      Authors: Ruth O. Ngwu, Ryan Lindeau, Laura M Bielecki, Christopher J. Daly
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Introduction: Pursuant to the COVID-19 pandemic, an executive order issued by the New York State (NYS) governor allowed pharmacists to act as laboratory directors for a limited-service laboratory (LSL) to order and perform Food and Drug Administration (FDA) and Emergency Use Authorization (EUA) Clinical Laboratory Improvement Amendment (CLIA)-waived COVID-19 point-of-care testing (POCT). Objectives: To (i) assess the status of NYS community pharmacists with POCT in the early stages of the COVID-19 pandemic, (ii) assess the readiness and willingness of community pharmacists to incorporate COVID-19 POCT into their workflow during a pandemic, and (iii) assess community pharmacists’ perception of the barrier to initiating COVID-19 POCT. Methods: This is a prospective cross-sectional study conducted from February 4 to February 21, 2021. An electronic survey consisting of 66 Likert-type questions, select all that apply, and fill-in-style questions were emailed to 250 Community Pharmacy Enhanced Service Network (CPESN) NY pharmacies, with a follow-up email sent halfway into the data collection period. The data were analyzed using descriptive statistics. Results: The result indicated that most participants (median = 5) demonstrated readiness and willingness to offer COVID-19 testing. Barriers to COVID-19 POCT were identified: impact on pharmacy workflow (59%), lack of payment mechanism (55%) and lack of sufficient training (21%). Most participants expressed interest in continuing POCT beyond the pandemic (86.1%). Conclusion: Community pharmacists in NYS reported willingness to initiate COVID-19 POCT. Addressing the identified barriers, such as workflow disruption and reimbursement challenges, will enable pharmacies to be better prepared to provide patient care, including POCT.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-10-15T06:07:26Z
      DOI: 10.1177/08971900221134642
       
  • Impact of Pharmacist Monitoring of Serum Triglycerides for Critically Ill
           Patients Receiving Propofol

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      Authors: Katelin A. Ivey, Scott Bolesta
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: Elevated serum triglycerides due to the use of propofol for sedation in the ICU is associated with adverse effects and serum triglyceride monitoring may be improved by pharmacists. Objective: To determine if there was improvement in serum triglyceride monitoring in ICU patients receiving propofol for sedation after implementation of a pharmacist-driven triglyceride monitoring protocol. Methods: This was a single-center pre-post-intervention retrospective cohort study. The protocol was implemented on January 10 2019. Data were collected over 1 year, and patients were divided between those started on propofol before and after protocol implementation. Results: There were 412 patients included in the final analysis with no significant differences between groups. There was a significant increase in the number of patients who had a triglyceride concentration obtained after protocol implementation (31.1% pre-vs 64.0% post-protocol; P < .001). For patients on propofol greater than 24 h, there was a significant increase in baseline triglyceride concentration obtained (7.6% pre-vs 15.1% post-protocol; P = .043). More instances of elevated triglyceride concentrations were identified by pharmacists than other providers (9 vs 5; P < .001). Time between propofol being ordered and first triglyceride concentration ordered was shorter (.86 days pre-protocol vs .71 days post-protocol; P = .064), but not statistically significant. Conclusion: Implementation of a pharmacist-driven protocol in the ICU increased the number of serum triglyceride levels obtained for patients receiving propofol for sedation. Pharmacists can improve triglyceride monitoring in patients receiving propofol and future studies should investigate the impact on outcomes.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-10-14T10:11:23Z
      DOI: 10.1177/08971900221134646
       
  • Comparison of A1c Reduction, Weight Loss, and Changes in Insulin
           Requirements With Addition of GLP-1 Agonists vs SGLT-2 Inhibitors in
           Patients Using Multiple Daily Insulin Injections

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      Authors: Gunther Wehrman, Micah Halton, Brynn Riveland, Emily Potter, Melinda Gaddy
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Objective: To determine whether Glucagon-Like Peptide 1 (GLP-1) agonists or Sodium Glucose Transporter 2 (SGLT-2) inhibitors result in greater A1c reduction, weight loss, and reduction of insulin requirements in veterans using multiple daily doses of insulin. Methods: This retrospective, single-site, cohort study included patients of VA Eastern Kansas Health Care System with a diagnosis of Type II Diabetes utilizing multiple daily dose insulin and an SGLT-2 inhibitor or GLP-1 agonist. SAS Enterprise Guide was utilized to complete a multivariate analysis of variance to evaluate all outcomes. Key Findings: 150 patients met selection criteria. The GLP-1 group averaged a .65% reduction in A1c compared to a 1.05% reduction in the SGLT-2 group (P = .1397). The Basal insulin dose was reduced by 5.5 units in the GLP-1 group vs 2.45 units in the SGLT-2 group (P = .3132), and 7.12 units vs 8.14 units respectively for short-acting insulin (P = .8170). The resulting weight reduction was 4.1 Kg in the GLP-1 group compared to 3.6 Kg in the SGLT-2 group (P = .6993). Conclusion: The results suggest there is not a statistically significant difference in changes to A1c, insulin requirements, or weight after 1 year of treatment with an SGLT-2 vs GLP-1 in patients using multiple daily insulin injections.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-10-13T04:02:36Z
      DOI: 10.1177/08971900221134174
       
  • Transplant Pharmacists’ Experience With Telehealth During the
           COVID-19 Pandemic

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      Authors: Karen Khalil, Demetra Tsapepas, Patricia West-Thielke
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundThe adoption of telehealth became a necessity for healthcare organizations during the COVID-19 pandemic. Transplant pharmacists are integral members of the multi-disciplinary care team who quickly adapted application of these technologies to ensure continuity of care.ObjectiveTo assess transplant pharmacists’ experience with telehealth during the COVID-19 pandemic.MethodsA 23-question online survey was developed to assess transplant pharmacists’ experience with telehealth during the COVID-19 pandemic.ResultsForty-five pharmacists responded to the survey from a broad range of transplant centers. The majority of respondents indicated infrequent use of telehealth (98%) before the COVID-19 pandemic, but this was significantly changed during the pandemic with only 9% reporting infrequent use. Pharmacists anticipated a decrease in future use, but 91% of respondents stated they would like to continue utilization of telehealth in their practice post-pandemic.ConclusionsThe adoption of telehealth during COVID-19 was widespread and has the potential to facilitate continuity of care. Though pharmacists anticipated a decrease in future use, a majority favored continued utilization of telehealth in their practice.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-10-11T01:24:35Z
      DOI: 10.1177/08971900221132594
       
  • Individual and Community-Level Characteristics and Adherence to Specialty
           Medications

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      Authors: Amanda M. Kibbons, Ryan Moore, Leena Choi, Megan Peter, Autumn D. Zuckerman
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: Understanding risk factors for nonadherence can help specialty pharmacies optimize resources to prevent nonadherence and inform risk-stratification processes. Objective: To determine which individual and community-level characteristics are associated with nonadherence to specialty medications. Methods: We analyzed a cohort of patients enrolled in a prospective randomized controlled trial having filled a specialty medication at least 4 times in the previous 12 months with a proportion of days (PDC) covered < 0.90. We collected patient age, gender, race, medication administration type, therapy start date, home address, insurance type, and online patient portal status from the electronic health record. An ordinal logistic regression model was used to assess the association of nonadherence with individual and community-level patient characteristics. Results: Most patients were female (68%), white (82%), and held commercial insurance (58%) with a median age of 53 (interquartile range [IQR] 40, 64) years. Patients were mostly from the adult rheumatology (35%), multiple sclerosis (20%) and lipid (17%) clinics. Given a 10-year increase in age, patients had lower odds of having lower PDC (odds ratio [OR] = 0.82, 95% confidence interval [CI] = 0.71-0.94, P = 0.005). Patients on therapy greater than or equal to 1 year had half the odds of having lower PDC relative to patients on therapy less than 1 year (OR = 0.52, CI = 0.35 – 0.75, P < 0.001). No statistically significant associations were found between PDC and gender, race, insurance type, route of administration, clinic type, patient portal status, median income, percent receiving government assistance, or percent with no health insurance. Conclusion: Patients with younger age and shorter duration on treatment may be at-risk for lower adherence. Specialty pharmacies may benefit from targeting adherence interventions to these groups.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-10-07T06:34:26Z
      DOI: 10.1177/08971900221131933
       
  • The Impact of the COVID-19 Pandemic on the Transplant Pharmacist Workforce

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      Authors: Karen Khalil, John Lyons, Jeffrey J. Teuteberg, Erik J. Henricksen
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: The COVID-19 pandemic has placed an unprecedented strain on the US healthcare system, greatly impacting transplant centers. Objective: The purpose of this survey was to evaluate the impact of the COVID-19 pandemic on the transplant pharmacist workforce. Methods: A survey was disseminated electronically to assess the impact of the COVID-19 pandemic on the transplant pharmacist workforce. Respondents were asked to give background regarding transplant center, patient, population, and departmental staffing. Results: There were 67 total respondents from 56 transplant centers. In response to the COVID-19 pandemic, 55% of centers reported stopping non-life saving transplants, and a majority (89%) stopped living donor transplants altogether. The banning of caregivers on-site during education, reduction of bedside education teaching, and cancelling of group teaching classes occurred at 46%, 40%, and 22% of centers, respectively. Consequently, 42% of pharmacists surveyed felt that their confidence in patient and caregiver’s understanding of medications had decreased since these changes have been implemented. Conclusions: Pharmacist perception of patient and caregiver understanding of transplant medications has decreased since before the COVID-19 pandemic. As health systems strategize resource allocation throughout the pandemic, the importance of patient education must be prioritized to sustain and improve transplant outcomes.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-10-07T06:20:46Z
      DOI: 10.1177/08971900221131906
       
  • 4-Factor Prothrombin Complex Concentrate Dosing Strategies: A
           Retrospective Evaluation

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      Authors: Breyanna Reachi, Jenna Negrelli, Marie Rapier, Abby Hickman
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      ObjectivesDetermine indication specific 4-Factor prothrombin complex concentrate (4FPCC) dosing strategies within a hospital system and subsequent effectiveness. Background: 4FPCC is FDA approved for reversal of vitamin K antagonists (VKA) for acute major bleeding or need for urgent surgery/invasive procedure. Since its approval, off label use has expanded to include direct oral anticoagulant reversal and perioperative hemostasis. Optimal dosing strategies remain controversial, and recent studies have evaluated fixed-dose regimens with lower doses than those recommended in product labeling. Methods/Materials: Retrospective cohort with manual chart review for patients who received 4FPCC spanning 2 years. Primary outcome was to characterize dosing. Secondary outcomes were INR normalization, hemostatic efficacy, in-hospital mortality, and renal function change. Results: Of the 300 patients evaluated, 80% received 4FPCC for anticoagulant reversal, with 66% of those for VKA and 34% for DOAC. The remaining 20% received 4FPCC for a non-reversal indication. Of the patients requiring anticoagulation reversal, 25% received doses lower than recommended and 6% received higher. 71% of patients received 4FPCC for life-threatening bleed, and 45% of them had intracranial hemorrhage. Higher mortality with higher than recommended doses was the only statistically significant secondary outcome (P = .018). Conclusion: We found that lower doses than recommended were used in a significant number of patients. The higher than recommended doses group constituted a small proportion of patients and the higher mortality was attributed to patient acuity on presentation. Additional studies evaluating dosing approach are required to determine lowest effective dosing for various indications.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-10-07T04:34:18Z
      DOI: 10.1177/08971900221131924
       
  • Cefazolin-Associated INR Elevation: A Case Report

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      Authors: Jeremiah L. Barnes, Inez E. Pabian, Abigail K. Bonjour, Karolyn A. Mosbacher, Grace C. Mortrude, Kyle A. Beasley
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      PurposeTo describe a case of significantly elevated international normalized ratio (INR) in a patient on apixaban receiving treatment with intravenous cefazolin in the setting of coronavirus disease 2019 (COVID-19) infection and malnutrition.SummaryA 74-year-old male patient on apixaban receiving cefazolin for osteomyelitis in the setting of COVID-19 and poor nutritional intake presented with internal jugular tunneled catheter site bleeding and an INR of greater than 22.5. Laboratory abnormalities and bleeding concerns were successfully managed with vitamin K and changing antimicrobial therapy from cefazolin to daptomycin. Follow-up labs one week later demonstrated a sustained improvement in coagulopathy.ConclusionINR prolongation believed to be secondary to cefazolin can be effectively managed with administration of vitamin K and conversion of antimicrobial therapy to an alternative agent.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-10-07T03:49:49Z
      DOI: 10.1177/08971900221132680
       
  • Outcomes Associated with De-escalation of Antibiotics to Target Positive
           Cultures when Treating Febrile Neutropenia

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      Authors: Rebecca Rainess, Peter Campbell, Jennifer Santamala, Christine J. Kubin, Monica Mehta
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: Patients with hematologic malignancies frequently develop febrile neutropenia (FN) and subsequently receive long courses of broad-spectrum antibiotics. Limited data is available on de-escalation strategies. Methods: This was a retrospective observational cohort study of adult patients with a hematologic malignancy, FN, and positive culture results from June 2017 to June 2020. A conventional group (patients who remained on empiric, broad-spectrum agents) was compared to a de-escalation group (patients whose antibiotic therapy was de-escalated based on culture results). The primary outcome was the incidence of recurrent fever or antibiotic escalation due to infection while neutropenic. Results: Of the 123 patients included, the composite primary outcome occurred in 35.3% in the de-escalation group and 39.3% in the conventional group (P = .83). For secondary outcomes, median time to recurrent fever was 7 days in the de-escalation group and 7 days in the conventional group (P = .73). Incidence of Clostridioides difficile was 5.9% in the de-escalation group and 6.7% in the conventional group (P = 1.00). Development of multidrug resistant pathogens during hospital admission was 20.6% in the de-escalation group and 14.6% in the conventional group (P = .59). Median length of broad-spectrum antibiotics was 3 days in the de-escalation group and 8 days in the conventional group (P < .001). All-cause mortality within 30 days was 0 in the de-escalation group and 5.6% in the conventional group (P = .32). Conclusion: In a small sample of patients with a hematologic malignancy and FN, de-escalating antibiotics based on positive cultures decreased the duration of antibiotic therapy without increasing the rate of antibiotic failure.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-10-06T03:07:14Z
      DOI: 10.1177/08971900221132120
       
  • Opportunities for Community Pharmacists to Counsel Patients With Epilepsy
           and Seizure Clusters to Overcome Barriers and Foster Appropriate Treatment
           

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      Authors: Barry Gidal, Timothy Welty, Jon Cokley, Michelle Farrell, Patricia Shafer, Adrian L. Rabinowicz, Enrique Carrazana
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Some patients with epilepsy experience seizure clusters, which may be defined as 2 or more seizures occurring within 24 hours. Left untreated, seizure clusters increase the risk for physical injury and may progress to status epilepticus, irreversible neurologic injury, and death. Rescue therapy is based on benzodiazepine treatment. Prompt, appropriate use should be specified in patients’ individualized seizure action plans. Most seizure clusters occur outside the hospital setting. The ideal rescue therapy allows for easy and quick administration by a nonmedical person, which may minimize the need for intervention by emergency medical personnel or transportation to the hospital. In the 2 decades before the approval of 2 intranasal benzodiazepines in 2019 and 2020, rectal diazepam was the only route of administration approved by the US Food and Drug Administration specifically for seizure clusters. Each of the approved intranasal formulations has a unique profile. Both offer a convenient and socially acceptable route of administration. Recognition of seizure clusters and timing of proper administration are key to successful use of rescue therapy. Pharmacists’ counseling plays an important role in reinforcing when and how to appropriately administer rescue therapies and the importance of consistently using rescue treatment when indicated to promote effective management. This review includes resources for pharmacists, patients, and caregivers; reviews currently available treatments; and discusses seizure action plans that support effective treatment of seizure clusters.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-10-04T12:02:35Z
      DOI: 10.1177/08971900221126570
       
  • Approaches to Reduce Use and Duration of Anti-MRSA Agents for
           Antimicrobial Stewardship Programs: A Review of Recent Literature

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      Authors: Ethan Y. Wang, Jennifer E. Girotto
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Antimicrobial stewardship programs (ASPs) have the potential to effectively deescalate unnecessary methicillin-resistant Staphylococcus aureus (MRSA) coverage. This review summarizes literature published from 2014 through 2021 describing contemporary ASP methods and their resulting effectiveness at reducing anti-MRSA agent use (ie vancomycin, linezolid, daptomycin, ceftaroline, and clindamycin). This review of the literature examined the following strategies, which had reports of success in either decreasing the use or duration of anti-MRSA agents: prospective review and feedback, antibiotic timeouts, health system or department protocol changes, polymerase chain reaction (PCR) and rapid testing of patient samples. Most of the current literature continue to support most ASP interventions including antibiotic timeouts, pathways, and molecular testing including MRSA nasal PCRs and rapid diagnostic testing can be successful at reducing unnecessary anti-MRSA use.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-10-04T07:33:00Z
      DOI: 10.1177/08971900221130893
       
  • A Comparison of Midazolam and Propofol for Deep Sedation in Patients with
           Acute Respiratory Distress Syndrome Requiring Neuromuscular Blocking
           Agents

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      Authors: Janci D. Addison, Mitchell J. Daley, Molly Curran, Emily K. Hodge
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Purpose: The optimal agent for deep sedation in patients undergoing continuous infusion (CI) neuromuscular blocking agent (NMBA) use for acute respiratory distress syndrome (ARDS) is unknown. The purpose of this study is to compare the efficacy and safety of propofol and midazolam in ARDS patients requiring CI NMBA. Methods: A multi-center, retrospective study was performed in mechanically ventilated (MV) adult patients requiring CI NMBA for management of ARDS. The primary outcome was to compare the time to liberation from MV in patients sedated with propofol vs midazolam. Results: In the 109 patients included, there was no difference in time to MV liberation with propofol as compared to midazolam (121 hr [Interquartile range (IQR) 67 195] vs 98 hr [IQR 48, 292], P = .72). Median time to sedation emergence after NMBA discontinuation was shorter in patients receiving propofol (12.9 hr [IQR 19.8, 72.5] vs 31.5 hr [IQR 6.4, 34.6], P < .01). There were no significant differences in time to therapeutic sedation, ICU stay, mortality, and adverse events. Conclusion: Propofol may be an effective and safe alternative to midazolam for patients undergoing CI NMBA for ARDS. Additionally, patients receiving propofol may have a quicker return to light sedation after NMBA discontinuation.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-10-02T09:32:42Z
      DOI: 10.1177/08971900221131420
       
  • An Emergency Department Quality Improvement Project for Intravenous
           Levetiracetam Administration

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      Authors: Caitlin Rublee, Emilie Calvello Hynes, Nicole Paavola, Kathryn Tremolet de Villers, Julie McLaughlin
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: Levetiracetam is a readily available, safe anticonvulsive medication. It is frequently administered as IV piggyback with a pump, carrier fluid, and tubing. The Established Status Epilepticus Treatment Trial demonstrated levetiracetam being similarly effective to previously used treatments in doses up to 4500 mg administered over 10 minutes. Objective: We sought to compare usage, cost, and waste of IV piggyback with IV push administration of levetiractam following implementation of an IV push protocol in an academic emergency department. Methods: A three-month review of levetiracetam administration was done following protocol implementation using IV push for initial treatment of benzodiazepine-refractory status epilepticus. The review quantified the number of IV push vs IV piggyback doses for all indications and evaluated cost of supplies necessary for administration. Results: During the study period, 137 patients received 142 doses of IV levetiracetam. Fifty-one doses (36%) were given as IV push rather than IV piggyback. The majority of doses 116 (82%) were 1000-2000 mg and 11 doses (8%) 3500-4500 mg. Estimated three-month savings with complete transition of IV piggyback to IV push would exceed $6000 just in our ED. The amount of sterile solution carrier fluid was also reduced and IV pump time freed. Conclusion: Implementation of an emergency department IV push levetiracetam protocol resulted in cost savings. Opportunities remain to improve clinical implementation practices. Medication administration represents one crucial target area where healthcare systems can implement policies to reduce waste and commit to climate-smart health care.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-10-02T09:29:42Z
      DOI: 10.1177/08971900221131920
       
  • Keeping Up With the Literature: New Solutions for an Old Problem

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      Authors: Katy S. Stephens, Bryan P. White
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Pharmacists utilize medical literature to provide evidence-based care to patients. However, staying up to date with current literature can be challenging, especially with the increasing number of publications produced in a growing number of journals. While evaluating literature is a standard in pharmacy education and training, the specific skill of keeping up with the literature is often not included. We explore the following 5 strategies to help pharmacists stay up to date with the literature: medical journals, social media, podcasts, teaching/precepting, and continuing education/board certification. Pharmacists are encouraged to evaluate which tactics fit best into their practice and incorporate them into their workflow, as well as routinely reflect on the system they create and continue to modify as needed.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-10-02T08:54:02Z
      DOI: 10.1177/08971900221131907
       
  • Agranulocytosis Associated With Use of Sulfamethoxazole/Trimethoprim in a
           Healthy Adult

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      Authors: David Bunch, Carolyn Brands, Diana R. Langworthy
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Purpose: A case of sulfamethoxazole/trimethoprim-induced agranulocytosis is reported. Summary: A 53-year-old healthy male presented to the emergency room with a fever of 102.7°F and was found to have a white blood cell (WBC) count of 0.6 × 103 cells/μL with an absolute neutrophil count (ANC) of 0.0 x 103 cells/μL. He had recently completed a 10-day course of sulfamethoxazole/trimethoprim for left lower extremity cellulitis. During admission, a bone marrow biopsy was performed which was not concerning for malignancy and no cause for the agranulocytosis other than the sulfamethoxazole/trimethoprim was identified. The agranulocytosis resolved after 6 days of hospitalization with a WBC count of 8.9 × 103 cells/μL and an ANC of 4.1 x 103cells/μL on the day of discharge. Conclusion: A 53-year-old male developed agranulocytosis after 10 days of sulfamethoxazole/trimethoprim therapy for the treatment of a skin and soft tissue infection. His neutropenia resolved after sulfamethoxazole/trimethoprim discontinuation.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-09-27T11:16:47Z
      DOI: 10.1177/08971900221128854
       
  • Evaluating Medication Day-Supply for Improving Adherence and Clinical
           

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      Authors: Nina Ameli, William N. Jones
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Objectives: To compare a 90-day-supply and a less than 90-day-supply of medication on adherence to refilling prescriptions and clinical biomarkers for hemoglobin A1c (HbA1c), blood pressure (BP), and low-density lipoprotein (LDL). Methods: A retrospective chart review was completed for a cohort of patients prescribed an oral hypoglycemic agent (OHA), angiotensin-converting enzyme inhibitor (ACEI), or angiotensin II receptor blocker (ARB), and/or a statin. Data were categorized into 90-day-supply and less than 90-day-supply and on the minimum value for control determined by the CMS Star Ratings system. Adherence was defined by the Health Plan Quality Improvement Department as ≥ 85% of days covered. Clinical biomarker cutoffs were HbA1c (140 mm Hg or Diastolic BP ≥ 90 mm Hg regardless of SBP), and LDL (
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-09-26T12:23:29Z
      DOI: 10.1177/08971900221129424
       
  • Use of Valproic Acid for the Management of Delirium and Agitation in the
           Intensive Care Unit

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      Authors: Rebecca Swayngim, Candice Preslaski, Jordan Dawson
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Purpose: Assess the efficacy and safety of valproic acid (VPA) for delirium and agitation in the intensive care unit (ICU) as compared to the use of other antipsychotics. Materials and Methods: This was a retrospective cohort study of patients treated for delirium and agitation in the ICU. Patients were included if they had a Richmond Agitation-Sedation Scale ≥2 and Confusion Assessment Method for the ICU positive. Patients were split into two groups based on their VPA exposure. The primary outcome was delirium free days. Secondary outcomes included agitation free days, ICU length of stay (LOS), mechanical ventilation duration, and mortality. Results: One hundred eight patients were included, 49 patients in the VPA group and 59 patients in the control group. Baseline characteristics were similar between groups. There was no significant difference in the primary outcome (difference −.15, 95% CI: 0.63-.93, P = .70). There were no significant differences in agitation-free days, mortality, mechanical ventilation duration, or ICU LOS. Conclusions: Our findings suggest that VPA is associated with similar delirium and agitation-free days compared to other non-VPA medications, with some adverse effects. Larger prospective studies are needed to validate the routine use of VPA in this setting.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-09-26T03:34:05Z
      DOI: 10.1177/08971900221128636
       
  • Polypharmacy and Healthcare Service Use Among Prescription Opioid
           Poisoning Cases Age 50+

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      Authors: Namkee G. Choi, Bryan Y. Choi, Diana M. DiNitto, C. Nathan Marti, S. David Baker
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Objectives: To examine relationships between polypharmacy and level of healthcare service use among prescription opioid poisoning cases age 50 and older. Methods: Data came from the American Association of Poison Control Center’s National Poison Data System, 2015-2020. We used multinomial logistic regression to examine the study questions. Results: Of the 77 946 cases with prescription opioid exposures, 64.5% were managed at a healthcare facility (HCF). Of HCF-managed cases, 41.2% were treated/evaluated and released and 21.3% and 37.5% were admitted for noncritical care and critical care, respectively. Medications for cardiovascular disease, benzodiazepines, other types of sedatives/hypnotics, antipsychotics, muscle relaxants, acetaminophen, and gabapentin were associated with increased risk of admission to both noncritical and critical care compared to treatment/evaluation and release. Acetaminophen use had the highest relative risk ratios (RRRs) for noncritical care (1.70, 95% CI = 1.51-1.91) and critical care (1.56, 95% CI = 1.39-1.76). Each additional medication/substance used was associated with 1.14 (95% CI = 1.11-1.17) and 1.19 (95% CI = 1.16-1.22) greater risk of noncritical and critical care admissions, respectively. Conclusions: Among older-adult poison control center cases for prescription opioid exposures, co-use of several commonly prescribed/used medicines was associated with increased risk of admissions to both noncritical and critical care units. Careful monitoring of medication use among older adults who use prescription opioids may reduce the risk of unintentional and intentional opioid poisoning.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-09-24T08:54:17Z
      DOI: 10.1177/08971900221129656
       
  • Hormonal Therapy in Pretreated Patients With Recurrent Ovary Granulosa
           Cell Tumor

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      Authors: Izzet Dogan, Esra Aydin, Samet Topuz, Pinar Saip, Mehmet Y. Salihoglu, Adnan Aydiner
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Objective: To evaluate the effectiveness of hormonal therapy (HT) in patients with recurrent adult ovary granulosa cell tumors. Methods: The clinical and treatments features of the patients who received HT were studied retrospectively. The efficacy and safety of HT were evaluated. The Kaplan-Meier technique was used to conduct survival analysis. Results: The research involved a total of thirteen patients. The median age of the participants was 49 years (range: 34-61). Since diagnosis, the median number of surgeries has been three (range: 2-8). At least one chemotherapy regimen has been administered to 12 (92.3%) patients. Ten of the patients (76.9%) had at least two metastatic areas. Lung metastases were found in two (15.4%) of the patients. Inhibin B levels were elevated in 81.2% of patients before hormone treatment. The patients received different HTs (Leuprolide acetate + anastrozole-three patients, leuprolide acetate + tamoxifen-six patients, only anastrozole-three patients, only tamoxifen-one patients). The median progression-free survival was found 17.7 months (95 % CI: 14.7-20.6). In four (33.4%) patients, an overall response (complete or partial) was identified. A stable response was observed in eight (66.7%) patients. Conclusions: HT is effective in pretreated individuals with recurrent ovarian granulosa cell tumors, according to this research. Despite the limited number of patients and treatment variability, disease control was achieved in all patients. Also, we found that Inhibin B levels were associated with treatment response.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-09-23T10:35:50Z
      DOI: 10.1177/08971900221129679
       
  • Delayed and Non-Antibiotic Therapy for Urinary Tract Infections: A
           Literature Review

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      Authors: Jacob S. Midby, Andrew R. Miesner
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Urinary tract infections are among the most common infections encountered in the clinic and remain a top indication for women to receive antibiotics. Delayed antibiotic prescribing and non-antibiotic symptomatic therapies are treatment paradigms common to other uncomplicated infectious diseases, such as upper respiratory infections. We aimed to review the literature on delayed antibiotics and non-antibiotic treatments as alternatives to immediate antibiotic prescriptions for uncomplicated cystitis. A literature search was performed in PubMed, Google Scholar, and Web of Science to identify relevant clinical trials and reference lists of included articles were examined to find additional studies. All published trials where same day treatment with antibiotics was compared to scenarios where antibiotics were intentionally delayed or withheld or where antibiotics were compared to non-antimicrobial agents or placebo were analyzed. A total of 13 articles were included. Trials were grouped into categories based on their comparator groups: placebo (n = 5), delayed antibiotic therapy (n = 3), and symptomatic treatment (n = 5). Antibiotic delay and ibuprofen, while less effective than antibiotics in early microbiologic and clinical cure, may still be considered plausible alternatives to immediate antibiotic treatment in non-pregnant women with cystitis. Day 7 and later symptomatic resolution ranges from 26-75% with delayed or placebo therapy and 70-83% with nonsteroidal anti-inflammatory drugs. Symptom improvement, however, may be delayed compared to immediate antibiotics. These approaches have shown to decrease antibiotic use in primary care settings with low rates of pyelonephritis. Methodology included in these studies may be considered in stewardship interventions for outpatient clinics.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-09-22T10:34:35Z
      DOI: 10.1177/08971900221128851
       
  • The Association of Elevated Lactate With Multiple Vasopressor
           Administration in Patients With Septic Shock: A Retrospective Cohort Study
           

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      Authors: Kee Gales, Molly Hunt, Jacob Marler
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Purpose: In patients with septic shock and elevated lactate, there is limited evidence evaluating supplementary vasopressor use beyond vasopressin (AVP) and norepinephrine (NE). The purpose of this study is to describe vasopressor utilization and clinical outcomes based on lactate level. Methods: We conducted a retrospective study of patients with septic shock requiring NE. Patients were divided into 2 groups: baseline lactate level of ≥4 mmol/L (lactate group) or
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-09-20T10:40:25Z
      DOI: 10.1177/08971900221128640
       
  • Significant Publications on Infectious Diseases Pharmacotherapy in 2021

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      Authors: Nhi Nguyen, Hubert C. Chua, Ty Drake, Jinhee Jo, Stefanie Anne Stramel, Nancy N. Vuong, Anne J. Gonzales-Luna, Kelsey Olson, on behalf of the Houston Infectious Diseases Network
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Purpose: To summarize the most noteworthy infectious diseases (ID) pharmacotherapy articles published in peer-reviewed literature in 2021. Summary: Members of the Houston Infectious Diseases Network (HIDN) nominated articles that were deemed to have significant contributions to ID pharmacotherapy in 2021. These nominations included articles pertaining to both general ID, including coronavirus disease 2019 (COVID-19), and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pharmacotherapy. A total of 35 articles were nominated by HIDN: 30 articles pertaining to general ID pharmacotherapy and 5 articles with HIV/AIDS focus. To select the most influential articles of 2021, a survey was created and distributed to members of the Society of Infectious Diseases Pharmacists (SIDP). Of the 239 SIDP members who responded to the survey, there were 192 recorded votes for the top 10 general ID pharmacotherapy articles and 47 recorded votes for the top HIV/AIDS article, respectively. The top publications are summarized. Conclusion: Antimicrobial stewardship and the optimal management of infectious disease states continues to be a priority in the midst of the ongoing coronavirus disease 2019 (COVID-19) global pandemic. In light of the sheer volume of ID-related articles published in the past year, this review aims to aid clinicians in remaining up-to-date on key practice-changing ID pharmacotherapy publications from 2021.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-09-19T09:44:12Z
      DOI: 10.1177/08971900221128334
       
  • Web-Based Electronic Health Record Program: A Twelve-Month Evaluation on
           Pharmacist’s Intervention in Medicare Part D Annual Comprehensive
           Medication Review

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      Authors: Mok Thoong Chong, Desiree S. Chong
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Objective:The objective of this study was to evaluate the impact of pharmacist’s intervention on annual comprehensive medication review (Annual CMR) for Medicare Part D beneficiaries. Background: To develop a new approach to assess Medicare Part D Annual CMR using a technological tool. Methods: One hundred sixty-three (163) eligible Medicare Part D beneficiaries were enrolled. By using an Electronic Health Record (EHR) Program, the pharmacist was able to assess laboratory, pharmacy, diagnosis, and patient information. A post-medication review summary was provided to the medical providers and patients which included a medication action plan. At the end of 3 months, 6 months and 12 months after the medication review, data were collected, assessed and compared. Results: The study showed that pharmacist’s interventions were recommended to seventy-four (74) enrollees which comprised of 45% of the total enrollees. It showed that at 3-month, 6-month, and 12-month intervals after the medication review, the recommended interventions acknowledged and implemented by the medical providers were 20%, 51% and 64% respectively, which showed a significant difference over a 12-month period (P-value
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-09-19T06:43:52Z
      DOI: 10.1177/08971900221129009
       
  • Rates of Opioid Misuse Amongst Patients Receiving Pain Management for
           Sickle Cell Disease in An Urban Setting

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      Authors: Nadia Ahmed, Nkemjika Okany, Divita Singh, Dhakrit Rungkitwattanaku, Salome B. Weaver
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background and Objective: Sickle Cell Disease (SCD) is known to cause acute severe pain episodes known as vaso-occlusive crisis (VOC) mainly treated with opioid analgesics. Since the opioid epidemic there is an interest in determining the opioid misuse potential in these patients. Therefore, the primary objective of this study is to determine the rates of opioid misuse among patients with SCD by assessing the rate of unexpected drug screening results in a sickle cell disease clinic. Methods: This was a retrospective chart review study conducted at the outpatient sickle cell disease clinic. The primary independent variables were the prescribed opioid medications while the primary dependent variable was the collected opioid metabolite. Descriptive statistics, linear regression and multivariate logistic regression analysis were conducted using SPSS version 24. Results: A total of 100 participants were recruited from July 1, 2018, to June 30, 2020 with 71 included in the analysis. The total mean of morphine milligram equivalents (MME) for all participants was 71.1±104.9 with 71% of participants having a daily calculated MME of
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-09-19T05:57:48Z
      DOI: 10.1177/08971900221128335
       
  • Fidaxomicin-Associated Hypersensitivity Reactions: Report of a
           Morbilliform Drug Eruption

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      Authors: Radha R. Molleti, Monique R. Bidell, Alexandra W. Tatara
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      PurposeWe report a probable case of morbilliform drug eruption secondary to fidaxomicin in a patient with Clostridioides difficile infection (CDI).SummaryA 62-year-old female presented to our institution’s emergency department (ED) with symptoms consistent with Clostridioides difficile infection. The patient was prescribed 2 weeks of oral vancomycin for CDI prior to presentation. Given insufficient response to vancomycin, the patient was started on fidaxomicin with a planned 10-day course. After 2 doses of fidaxomicin, the patient developed a rash on her back that spread within 24 hours. The patient did not experience relief upon administration of a variety of medications for allergic reaction. Improvement was noted upon discontinuation of fidaxomicin. The Food and Drug Administration reports that < 2% of adults treated with fidaxomicin experience a rash as an adverse effect.ConclusionFidaxomicin was a probable cause of morbilliform drug eruption in our patient with CDI. The patient improved upon discontinuation of fidaxomicin.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-09-16T07:36:59Z
      DOI: 10.1177/08971900221078780
       
  • Avatrombopag for the Treatment of Immune Thrombocytopenia and
           Periprocedural Thrombocytopenia Associated With Chronic Liver Disease

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      Authors: Thuy B. Tran, Lauren Downing, Joseph B. Elmes, Justin R. Arnall, Donald C. Moore
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Objective: To review the pharmacology, pharmacokinetics, clinical efficacy, safety, dosing and administration, and place in therapy of avatrombopag for the treatment of immune thrombocytopenia and chronic liver disease-associated thrombocytopenia. Summary: Avatrombopag is an orally administered thrombopoietin receptor agonist approved for the treatment of immune thrombocytopenia and is the first oral thrombopoietin receptor agonist approved for the treatment of perioperative thrombocytopenia associated with chronic liver disease in adults. The efficacy and safety of avatrombopag has been demonstrated in a multicenter, randomized, double blind, placebo-controlled phase III study in the setting of immune thrombocytopenia and in 2 identically designed, multicenter, randomized, double blind, placebo-controlled phase III trials in the setting of thrombocytopenia associated with chronic liver disease. The most common adverse events reported in the clinical trials were headache, fatigue, and gastrointestinal toxicities. The incidence of bleeding events was comparable between the avatrombopag and placebo treatment groups in each study. Avatrombopag has not been shown to be associated with hepatoxicity and does not require food restriction like the other oral thrombopoietin receptor agonist for immune thrombocytopenia, eltrombopag. Also, unlike eltrombopag for immune thrombocytopenia, it can be dosed less frequently than once daily. Conclusion: Avatrombopag offers another safe and effective oral option for the treatment of immune thrombocytopenia without food restrictions and an alternative, transfusion-sparing option for thrombocytopenia associated with chronic liver disease patients undergoing surgery.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-09-15T12:55:11Z
      DOI: 10.1177/08971900221125827
       
  • Safety and Efficacy of Early Post-Operative Intravenous Iron Replacement
           In Patients With HeartMate III Left Ventricular Assist Device

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      Authors: Ryan M. Vesper, Lauren Kemp, Prashanth Iyer, Katelynn Granger, Christina T. Doligalski, Mirnela Byku, Ian B. Hollis
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundWhile guidelines suggest intravenous (IV) iron to improve functional status and quality of life (QoL) in patients with NYHA class II-III heart failure (HF), continuous flow left ventricular assist device (CF-LVAD) recipients were not included in early IV iron studies. Our study compared outcomes between patients who did and did not receive IV iron during the index admission following Abbott HeartMate III™ (HM 3) CF-LVAD placement.MethodsThirty-three adult patients with a HM3 placed at our institution who received early post-operative IV iron (n = 20) or no IV iron replacement (n = 13) were compared. The co-primary outcomes were mean change in quality of life (by the Minnesota Living with Heart Failure Questionnaire [MLHFQ]) and 6-minute walk distance (6MWD) from baseline to first>90 day clinic follow-up.ResultsAt first clinic follow-up there was no significant difference between the IV iron and no-IV iron groups in MLHFQ (−27 ± 38 vs −21 ± 41, P = .8822) or 6MWD (360 ± 740 vs 786 ± 722, P = .208).ConclusionPatients receiving IV iron during index admission following HM3 implantation did not experience an improvement in quality of life or functional capacity when compared to those who did not receive IV iron.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-09-14T08:38:10Z
      DOI: 10.1177/08971900221127500
       
  • Octreotide Dosing in the Medical Management of Chyle Leak Following
           Otolaryngologic, Thoracic, and Trauma Surgery: A 9-Year Evaluation

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      Authors: Kelly L. Strama, Timothy D. Rice, Jacob P. Ruff, Kristen E. Carter, Neil E. Ernst, Dalton J. Kuebel, Molly E. Droege
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: Chyle leak is a rare complication following otolaryngologic, thoracic, and trauma surgery wherein the thoracic duct is transected. Case reports and small case series describe octreotide for the medical management of chyle leak, but limited data exist to determine the ideal dose. Objective: To evaluate octreotide dosing in patients with acute chyle leak. Methods: This retrospective, single center, cohort study evaluated adult patients admitted to the otolaryngology, cardiothoracic, and trauma surgery teams over a 9-year period. Patients diagnosed with a chyle leak who received octreotide were eligible for inclusion. Groups were defined as successful medical management or failure requiring definitive surgery. The primary endpoint was daily octreotide dose between groups. Results: Forty-seven patients were included with 29 (61.7%) admitted to the otolaryngology service and 44 (93.6%) with surgical complication as the chyle leak cause. Thirty-two (68.1%) patients had successful medical management while 15 (31.9%) patients failed and required surgical intervention. There was no difference in median daily octreotide dose (250 [IQR, 170-288] µg vs 253 [IQR, 200-282] µg, P = .9). Octreotide weight-based dose, treatment duration, and route of administration were similar between groups. Daily drain output and complete bowel rest were significantly higher in the failure group. Daily drain output was identified as an independent risk factor for failure. Conclusion: Octreotide dose was similar in patients with and without successful medical management of chyle leak. Future studies are needed to determine optimal octreotide dosing and elucidate the relationship between octreotide, drain output, and surgical intervention need.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-09-13T11:44:31Z
      DOI: 10.1177/08971900221125831
       
  • Valacyclovir Neurotoxicity in Patients with End-Stage Renal Disease: Two
           Cases Reviewed

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      Authors: Bernadette Gublo, Amy Beth St Amand, Anupama Menon, Alissa A Scalise
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      PurposeThe objective of this case series is to highlight different manifestations of valacyclovir associated neurotoxicity (VAN) and demonstrate the importance of adjusting medication appropriately in patients with end-stage renal disease (ESRD) on hemodialysis to prevent these complications.SummaryValacyclovir is a medication used to treat herpes zoster infection, commonly known as shingles. Valacyclovir is renally cleared and can accumulate in patients with renal dysfunction leading to severe side effects due to the prolonged half-life. VAN is a common adverse effect in patients with underlying kidney disease, that can be easily prevented if valacyclovir is properly dosed. This case series details the clinical outcomes of two elderly patients who were prescribed valacyclovir at six-times the recommended dose based on their renal function. Failure to reduce the dose of valacyclovir resulted in severe neurological and physical manifestations that required hospital admission and emergent hemodialysis.ConclusionThis case series details the importance of adjusting valacyclovir dose based on renal function. In patients with ESRD, the half-life of valacyclovir can be up to 14 hours, therefore hemodialysis should be utilized in severe cases of neurotoxicity to improve rapid excretion of the drug and promote rapid recovery from VAN.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-09-13T06:15:52Z
      DOI: 10.1177/08971900221127061
       
  • Utility of a Diabetes Medication Poster in a Primary Care Clinic

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      Authors: Wasif E. Shamsi, Tracey L. Mersfelder, Kevin J. Kavanaugh
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundDiabetes with related complications is a common disease state seen in primary care and available therapies have increased exponentially. It is difficult for a busy primary clinician to know and utilize these options efficiently.ObjectiveThe objective was to determine whether creating a diabetes medication poster that included costs, drug classification, adverse effects, and clinical outcomes/contraindications/cautions for use in an internal medicine/medicine-pediatric clinic improves resident and faculty knowledge, comfort, and awareness of those medications.MethodsThis quality improvement prospective study was designed to evaluate the utility of a diabetes medication poster in a medicine/medicine-pediatric clinic over a 2-month period. A pre and post survey was electronically sent to all residents and faculty to assess their level of confidence and knowledge of diabetes medication treatment before and after the poster was distributed. This study was classified as exempt by the Institutional Review Board.ResultsThere were 40 physicians that responded to the pre survey and 31 to the post survey. Both surveys revealed>90% agreed or strongly agreed that the poster would decrease risk of adverse reactions, help control cost, and increase confidence to providers about diabetic medications. The knowledge score increased pre vs post survey (P = .0398).ConclusionThere are a myriad of tools that can be utilized to help navigate complex diseases. Posters have rarely been evaluated. Physicians viewed the diabetes medication poster as favorable to help decrease adverse effects and cost while increasing knowledge. Areas where visual aids could be effective without overwhelming the providers should be explored.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-09-09T11:19:51Z
      DOI: 10.1177/08971900221125824
       
  • Cefepime-Associated Neurotoxicity in a Pediatric Patient With Stage V
           Chronic Kidney Disease

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      Authors: Horace Rhodes Hambrick, Kathryn Pavia, Sonya Tang Girdwood, Danielle Lazear, John Michael Taylor, Stefanie Benoit
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundStudies in adult patients suggest cefepime can cause neurotoxicity, including disorientation, seizures, and coma, particularly when present at high concentrations. Patients with underlying kidney dysfunction or central nervous system anomalies are at particularly high risk. There is a relative paucity of pediatric literature on the neurotoxic effects of cefepime.Case ReportHerein is reported the case of a 2-year-old patient with chronic kidney disease receiving cefepime for Serratia marcescens bacteremia who experienced agitation, tremor, and inconsolability in the setting of an elevated cefepime trough that improved with cefepime discontinuation alone.ConclusionsPediatric patients with acute and chronic kidney disease are at risk of cefepime-related neurologic changes. Therapeutic drug monitoring for cefepime in patients with kidney dysfunction or baseline neurologic abnormalities may help inform appropriate antimicrobial dosing and avoidance of toxicity.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-09-09T05:41:49Z
      DOI: 10.1177/08971900221125000
       
  • Real-World Reversal of Factor Xa Inhibition in the Setting of Major
           Life-Threatening Bleeding or Urgent Surgery

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      Authors: Lauren E. Schmidt, Matthew S. Hinton, Niels D. Martin
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: Management of major life-threatening bleeding with factor Xa (FXa) inhibition poses complex challenges involving novel direct reversal agents competing with non-specific preexisting strategies. The recent availability of andexanet alfa (AA) led to a health-system guideline incorporating its use alongside the most commonly used historic agent, four-factor prothrombin complex concentrate (4F-PCC). Objectives: The objective was to characterize the use and efficacy of AA and 4F-PCC for reversal of FXa inhibition after implementation of the health-system guideline. Methods: This multi-hospital, retrospective cohort study included patients aged>18 years administered either AA or 4F-PCC between October 2018 to June 2020 with the indication for urgent reversal of FXa inhibitor-induced coagulopathy. The primary outcome assessed hemostatic efficacy between treatment groups. Secondary outcomes evaluated adjunct blood product administration, incidence of repeat pharmacologic reversal, incidence of thromboembolism, intensive care unit and hospital length of stays, and in-hospital mortality. Results: Eighty-five patients were included; 33 patients received AA and 52 patients received 4F-PCC. Effective hemostasis was achieved at similar rates in both treatment groups (84.8% vs 76.9%; P = .373). Thrombotic events occurring during the observed hospitalization were more frequent among the AA treated group (18% vs 3.8%, P = .027). No differences were observed for other secondary outcomes. Conclusion: Guideline use resulted in similar rates of effective hemostasis with a higher incidence of VTE in patients receiving AA. Further exploration with a larger, prospective study to evaluate these findings is warranted.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-09-09T04:18:42Z
      DOI: 10.1177/08971900221125516
       
  • Vancomycin With Concomitant Piperacillin/Tazobactam vs. Cefepime or
           Meropenem Associated Acute Kidney Injury in General Ward Patients: A
           Multicenter Propensity Score-Matched Study

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      Authors: Ivan A. Komerdelj, Mitchell S. Buckley, Paul A. D’Alessio, Delia S. Ziadat, Emir Kobic, Pooja Rangan, Sumit K. Agarwal, Nicole C. Tinta, Melanie J. Yerondopoulos, Sandra L. Kane-Gill
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: Concurrent administration of vancomycin and piperacillin/tazobactam (VAN+PTZ) may increase the risk of acute kidney injury (AKI) in hospitalized patients. Comprehensive characterization of VAN+PTZ associated AKI and recovery patterns remains lacking in previous reports. Objective: To compare the incidence of AKI associated with VAN+PTZ compared to either cefepime (CEF) or meropenem (MER) with VAN in adult general ward patients. Methods: A multicenter, retrospective, propensity score cohort study was conducted in non-critically ill adult patients. Included patients were concurrently administered VAN+PTZ or VAN+CEF/MER. Patients developing AKI ≤48 hours following combination therapy were excluded. The primary endpoint was to compare the incidence of AKI between study groups. Multivariable Cox regression modeling in predicting AKI was also conducted. Results: A total of 3199 patients met inclusion criteria and were evaluated. The incidence of AKI in VAN+PTZ and VAN+CEF/MER groups were 16.4% and 8.7%, respectively (P < .001). The onset to AKI was 1.8 days earlier with VAN+PTZ compared to VAN+CEF/MER (P < .001). Multivariable prediction model showed concomitant VAN+PTZ was identified as an independent risk factor of developing AKI (HR 2.34, 1.82-3.01, P < .001). The VAN+PTZ group experienced significantly higher rates of severe AKI (stage II or III) compared to the VAN+CEF/MER group (P = .002). No differences in the AKI recovery patterns were found between study groups. Conclusions: Concomitant VAN+PTZ in adult general ward patients was independently associated with an increased risk of AKI overall. More severe AKI was also associated with VAN+PTZ.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-09-08T07:47:31Z
      DOI: 10.1177/08971900221125518
       
  • Evaluation of Dexmedetomidine’s Effect on Temperature in Obese
           Critically Ill Patients

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      Authors: Sara A. Atyia, Anthony T. Gerlach, Keaton S. Smetana, Molly J. Thompson, Casey C. May
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      IntroductionPrevious literature showed an association between hyperthermia and dexmedetomidine (DEX) use for ongoing sedation in non-obese patients. The purpose of this study is to evaluate DEX’s effect on temperature in obese critically ill patients.MethodsThis single center, retrospective, cohort study included patients ≥18 years, admitted to a surgical or medical ICU, received DEX for ≥8 hours as a single continuous infusion sedative, and weighed ≥120% of ideal body weight. Patients were excluded if they had a fever (≥38°C) and positive cultures within 48 hours of DEX initiation. The primary endpoint was a fever (Tmax of ≥38°C) within 48 hours of DEX initiation.ResultsA total of 186 patients were included for evaluation. Forty-two patients (22.5%) had a fever during the first 48 hours of DEX initiation. Median weight was not different between the febrile and afebrile groups (99.4 [90.6-122.4] vs 97.6 [81.6-114.2] kg, P = .6). Median change from baseline temperature for all patients within 48 hours was an increase of .5 (.1-.8) °C, P < .001. In multiple regression analysis, duration of DEX and baseline temperature were the only significant predictors of fever development with an adjusted odds ratio of 1.041 (95% CI 1.009-1.074, P = .012) and 7.058 (95% CI 3.307-15.064, P < .001), respectively.ConclusionsThis study suggests that there is a significant increase in body temperature from baseline for obese patients on DEX. Duration of DEX and baseline temperature were found to be risk factors for fever development in this population. Further studies are warranted.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-09-03T05:04:18Z
      DOI: 10.1177/08971900221125015
       
  • Pharmacists’ Impact on Older Adults Transitioning To and From Patient
           Care Centers: A Scoping Review

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      Authors: Stephanie L. Sibicky, Elizabeth K. Pogge, Carla J. Bouwmeester, Kirsten H. Butterfoss, Kelly R. Ulen, Kristin S. Meyer
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Objective: Expand upon previous reviews conducted on transitions of care (TOC) services with a focus on pharmacist interventions for older adults specifically transitioning to and from long-term care, acute rehabilitation, residential care facilities, care homes, skilled nursing, or assisted living facilities, collectively termed patient care centers (PCC). Data Sources: A PubMed and Ovid MEDLINE search was conducted including citations between 1974 and July 14, 2022. Bibliographies were also reviewed for additional citations. Methods: Articles included described pharmacist interventions during TOC for patients transitioning to and from PCC, were written in English, and reported outcomes pertaining to TOC services. Of 873 citations reviewed, 22 articles met the inclusion criteria. Results: Most studies were prospective in design with small sample sizes, of limited duration, and with varying interventions and reported outcomes. Most explored the transition from hospital to PCC and included a pharmacist intervention involving the identification of medication errors and discrepancies during the TOC. Few studies reported cost savings or 30- and 60-day reductions in readmission rates or mortality. Conclusions: This scoping review revealed a lack of robust clinical trials to assess the effectiveness of specific interventions performed by pharmacists for patients transitioning to and from PCC. Of the available data, pharmacist involvement within an interprofessional team can be an effective intervention to resolve medication discrepancies, reduce readmissions, and medication-related adverse events. An opportunity exists for future studies to explore ways to improve outcomes during TOC within PCC.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-09-03T01:38:09Z
      DOI: 10.1177/08971900221125014
       
  • An Effectiveness Study of a Primary Care-embedded Clinical Pharmacist-Led
           Intervention Among Patients With Diabetes and Medicaid Coverage

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      Authors: Kimberly Danae Cauley Narain, Chi-Hong Tseng, Douglas Bell, Amanda Do, Rob Follett, O. Kenrik Duru, Gerardo Moreno, Carol Mangione
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      ObjectiveExamine the impact of a primary care-embedded clinical pharmacist-led intervention (UCMyRx) on hemoglobin A1C and blood pressure control, relative to usual care, among patients with Type 2 diabetes (TD2) and Medicaid, in a large healthcare system.MethodsWe used data extracted from the Electronic Health Records system and a Difference-In-Differences study design with a 2:1 propensity-matched comparison group to evaluate the impact of UCMyRx on HbA1c and systolic blood pressure among patients with TD2 and Medicaid, relative to usual care.ResultsHaving at least one UCMyRx clinical pharmacist visit was associated with a significant reduction in HbA1c; (−.27%, P-value= .03) but no impact on SBP. We do not find differential UCMyRx effects on HbA1c or SBP among the subpopulations with baseline HbA1C ≥9% or SBP ≥150 mmHg, respectively. In Charlson Comorbidity Index (CCI)-stratified analyses we found stronger UCMyRx effects on HbA1C (−.47%, P-value< .02) among the CCI tercile with the lowest comorbidity score (CC1 ≤ 5). Significant UCMyRx effects are only observed among the subpopulation of Medicaid beneficiaries without Medicare (−.35%, P-value= .02).ConclusionsThe UCMyRx intervention is a useful strategy for improving HbA1c control among patients with TD2 and Medicaid.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-09-02T09:51:34Z
      DOI: 10.1177/08971900221125008
       
  • Long-Term Impacts of a Targeted Intervention in the Emergency Department
           on Inpatient Prescribing Practices

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      Authors: Briana J. Negaard, J. Priyanka Vakkalanka, Andrew S. Nugent, Brett A. Faine
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: In 2009, researchers successfully implemented an intervention to decrease the inappropriate prescribing of multivitamin infusions (MVIs) in the emergency department (ED) for patients presenting with alcohol-related illnesses. Objective: The purposes of our study were to determine the impact of the 2009 intervention on hospital-wide prescribing practices of vitamin therapies for alcohol-related illnesses, and to evaluate its long-term sustainability. Methods: A retrospective observational cohort study was conducted at a 60,000-visit ED, 811-bed academically-affiliated tertiary referral hospital with an average census of 515 and 714 patients in 2009 and 2019, respectively. Patients were included if they presented to the ED from 2009 to 2019 with an alcohol-related illness as defined by ICD-9 and ICD-10 codes. The primary outcome was the change in the monthly average of MVIs ordered inpatient within the first four months compared to the last four months of the study period. Secondary outcomes included changes in the mean distribution (MD) per month of thiamine administrations in the ED and inpatient setting, and MVIs ordered in the ED. Results: The MD of MVIs ordered per month decreased by 3.5% (95% CI −5.3, −1.7) in the inpatient setting and decreased by 1.4% (95% CI −2.5, −.3) in the ED from the beginning to the end of our study period. Conclusions: This study suggests the effects of an intervention made in the ED sustained impact over a 10-year timeframe, and decreased the use of MVIs in both the ED and hospital-wide.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-09-02T09:21:57Z
      DOI: 10.1177/08971900221125077
       
  • Impact of SMART Goals on Diabetes Management in a Pharmacist-Led
           Telehealth Clinic

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      Authors: Hannah E. Cook, Lindsay A. Garris, Alev H. Gulum, Carolyn J. Steber
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: Although there is evidence demonstrating successful implementation of SMART (specific, measurable, achievable, relevant, time-bound) goals in clinical settings, their impact on improving diabetes control has not been well-established. Objective: The primary objective was to determine the association between setting SMART goals and change in A1c among a Veteran population. Methods: This was an IRB-approved retrospective, case-control study. Patients with Type 2 diabetes mellitus (DM) managed virtually by a Clinical Pharmacy Specialist at a VA Community-Based Outpatient Clinic were eligible for inclusion. The electronic medical record was used to identify patients that set a SMART goal for DM management during the study timeframe. These patients were matched to a similar cohort of patients that did not set a SMART goal. Results: There were 100 patients included in the study. Goal A1c was achieved in 30% of patients in the SMART goal group compared with 24% of patients in the control group. There was a 1.2% reduction in A1c from baseline to 3 months in the SMART goal group vs .85% in the control group (P = .287). The mean number of medication changes per patient was 1.7 in the SMART goal group vs 2.1 in the control group (P = .174). Patients in the SMART goal group set an average of 1.5 SMART goals during the study period. Conclusion: Overall, patients that set SMART goals had clinically meaningful A1c lowering. Setting SMART goals for DM management in agreeable patients during diabetes telehealth visits may lead to fewer medication changes and improved diabetes control.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-09-02T07:11:16Z
      DOI: 10.1177/08971900221125021
       
  • Characterization of Risk Factors for Calciphylaxis in Hemodialysis
           Patients in the Fraser Health Renal Program – A Matched Case-Control
           Retrospective Review

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      Authors: Ashley Jang, Man Hon Mark Ho, Luzhi Yan
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      IntroductionCalciphylaxis is a lethal and rare disease characterized by ischemic and necrotic skin lesions caused by vascular calcification of adipose tissue. There have been many risk factors analyzed in the literature; however, the pathogenesis of calciphylaxis is still not well understood and treatment options are limited due to the lack of interventional studies. Our objectives were to describe risk factors, prevalence, incidence, and outcomes for calciphylaxis in hemodialysis patients within the Fraser Health Renal Program.MethodsThis was a retrospective matched case-control study of hemodialysis patients within the Fraser Health Renal Program. Hemodialysis patients with calciphylaxis were matched to hemodialysis patients without calciphylaxis in a 1:2 ratio for age and sex from September 2, 2017 to July 3, 2020.FindingsThere was a total of 40 calciphylaxis cases matched to 80 controls. In the univariate analysis, peritoneal dialysis, higher body mass index, lower serum iron, lower transferrin saturation, sevelamer, cinacalcet, warfarin, iron (PO), and insulin were associated with increased risk of calciphylaxis. In the multivariate analysis, only peritoneal dialysis, serum iron, sevelamer, and warfarin were identified as significant and strong risk factors associated with calciphylaxis. A low prevalence of 1.9% and high mortality rate of 57.5% at 12 months was found for calciphylaxis cases.DiscussionSignificant risk factors associated with calciphylaxis were peritoneal dialysis, serum iron, sevelamer, and warfarin. Future studies should further investigate the impact of minimizing exposure to these risk factors to reduce calciphylaxis development.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-08-28T12:40:25Z
      DOI: 10.1177/08971900221118444
       
  • Evaluating Pharmacist-Driven Interventions in a Primary Care Setting to
           Improve Proportion of Days Covered and Medication Adherence

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      Authors: Dominique D Davis, Genevieve Hale, Cynthia Moreau, Tina Joseph, Alexandra Perez, Elaina Rosario
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundMedication nonadherence is the leading cause of poor health outcomes and increased risk of hospitalizations. Previous studies have shown that pharmacist interventions can help improve medication adherence and CMS quality measures.ObjectiveThe purpose of this study was to examine the impact of clinical pharmacists’ interventions on medication adherence and PDC scores for ACEi/ARBs, statins, and noninsulin antidiabetic medications in the primary care setting.MethodsThis observational study was conducted at four primary care clinics to evaluate PDC scores pre- and post-pharmacist interventions from April 2020 to December 2020. Eligible patients were Humana Part D beneficiaries with a baseline PDC score
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-08-19T01:30:24Z
      DOI: 10.1177/08971900221111144
       
  • Evaluating the Effects of Ertapenem and Meropenem on Tacrolimus

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      Authors: Samantha Elledge, Kyle Klindworth, Jennifer Guy, Lindsey DeZotell, Ashley K. Holmes
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      PurposeFurther elucidate the potential drug interaction between tacrolimus and carbapenems in order to appropriately maintain the balance between infection treatment and therapeutic immunosuppression.MethodsThis study was a retrospective evaluation of solid organ transplant recipients on a stable dose of tacrolimus who received either ertapenem or meropenem. Patients were excluded if they had acute kidney injury, acute liver failure, concomitant initiation of medications that interact with tacrolimus, or were pregnant. The primary endpoint was the change in the median daily tacrolimus dose after meropenem or ertapenem administration. The secondary endpoint was the change in serum tacrolimus levels after meropenem or ertapenem administration.ResultsA total of 28 patients on tacrolimus were included in the study, 12 received ertapenem and 16 received meropenem. The median daily tacrolimus dose was 4.5 mg [IQR 3.0 mg – 8.8 mg] prior to and 3.4 mg [IQR 2.3 mg – 8.8 mg] after ertapenem administration. The median daily tacrolimus dose was 3.0 mg [IQR 1.6 mg – 5.5 mg] before and 3.0 mg [IQR 1.6 mg – 5.5 mg] after meropenem administration. No statistically significant difference in regard to the change in the median daily tacrolimus dose after ertapenem (P =.173) or meropenem administration (P =.755) was observed. There was no statistically significant difference found after ertapenem (P =.583) or meropenem (P =.317) administration when comparing pre- and post-administration median serum tacrolimus levels.ConclusionThe administration of ertapenem or meropenem did not affect serum tacrolimus levels or daily tacrolimus dose suggesting against empiric dose adjustments with co-administration.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-08-18T10:58:32Z
      DOI: 10.1177/08971900221117627
       
  • Experience With Pre-procedural Hemostatic Medications versus Platelet
           Transfusion in Patients With Platelet Storage Pool Deficiency

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      Authors: Katharine A. Lundy, Abigail Rabatin, Erica R. Davidson, Junan Li, Melissa J. Snider, Eric H. Kraut
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundStorage pool deficiency (SPD) is a rare bleeding disorder characterized by reduction in the number of delta granules within platelets, interfering with hemostasis. Current literature lacks well-designed studies from which to draw concrete conclusions regarding pre-procedural management of bleeding complications. Objective: The purpose of this study is to describe bleeding and safety outcomes of SPD patients receiving either pre-procedural platelet transfusions or platelet-sparing regimens. Methods: An exploratory retrospective cohort study was conducted among SPD patients, comparing major bleeding events between those who received platelet transfusion and those who received desmopressin, tranexamic acid, and/or aminocaproic acid within 24 hours prior to procedure. Results: Rates of major bleeding were not found to be higher among patients who received a platelet-sparing regimen [platelet-sparing: 2/25 (8%); platelet transfusion: 2/29 (6.9%); P = .99]. Incidence of non-major bleeding was higher in the platelet transfusion group, but this was not statistically significant [platelet-sparing: 0/25 (0%); platelet transfusion: 3/29 (10.3%); P = .24]. Treatment-related adverse effects were observed following 8 of 54 procedures (14.8%). Conclusion: Use of a platelet-sparing regimen was not associated with a significantly higher incidence of major or non-major bleeding events. Future prospective trials are recommended to compare outcomes between therapies.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-08-17T04:23:28Z
      DOI: 10.1177/08971900221119167
       
  • Augmented Renal Clearance in the Hematology and Oncology Populations: A
           Scoping Review for Pharmacists

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      Authors: Nicholas R. Nelson, Chelsea Mendoza, Denise H. Rhoney
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      IntroductionUntil recently, interest in renal function has focused on impairment to limit drug toxicity and increase medication safety. Augmented renal clearance (ARC) has been increasingly studied in multiple patient populations, including oncology, and could lead to decreased drug efficacy from faster elimination resulting in subtherapeutic concentrations. This scoping review sought to summarize ARC literature in cancer and identify areas of research to better inform pharmacy practitioners.Data SourcesElectronic databases were searched for English articles related to augmented/enhanced renal function/clearance following a framework for scoping reviews.Data SynthesisFourteen articles were analyzed, divided according to article objective: descriptive studies or ARC’s impact on pharmacokinetics/pharmacodynamics. ARC was most defined as creatinine clearance>130 mL/min/1.73 m2, reported in 10%-100% of patients. Febrile neutropenia in adult and pediatric patients, and age
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-08-16T05:37:29Z
      DOI: 10.1177/08971900221121362
       
  • Prevalence of QT-Prolonging Drug-Drug Interactions in Psychiatry: A
           Systematic Review and Meta Analysis

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      Authors: Saravana Kumar Ramasubbu, Archana Mishra, Soumitra Mandal
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: Drug-drug interactions (DDIs) are considered an emerging threat to the patients if undetected. DDIs can prolong QT interval, leading to fatal ventricular arrhythmia. Antipsychotics and antidepressants prescribed commonly to psychiatric patients have the propensity to prolong QT interval and can precipitate Torsades de pointes (TdP). This review aimed to summarize the prevalence of QT interval prolonging DDIs in psychiatric patients. Methods: This meta-analysis was carried out following the MOOSE (Meta-analysis of Observational Studies in Epidemiology) statement. Databases like Pubmed/MEDLINE, Google Scholar and Research gate were scanned for English language papers. Indexed terms from Medical Subject (MeSH) and other search terms for “QT prolongation”, “Drug interactions”, and “Psychiatry” were used to identify the articles. All published articles available until the day of the collection were considered. Outcome measures were analyzed with meta package in R language. Results: A total of 5 studies were eligible for inclusion. From the included studies, QT-prolonging DDIs were found in 14806 patients out of 30122 patients. The prevalence of QT-prolonging DDIs in psychiatric patients was found to be 42% (95% confidence interval: 21%, 66%). The factors associated with potential drug-drug interactions were related to patient characteristics such as polypharmacy, age and comorbid disease. Conclusion: This review concluded that psychiatric patients were prescribed the drugs/drug combinations which can prolong QT interval and can cause adverse effects on the cardiovascular system. Hence, it is important to implement precautionary safety interventions, be vigilant and prevent QT prolongation and adverse cardiac effects in clinical practice.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-08-14T07:27:58Z
      DOI: 10.1177/08971900221121371
       
  • Impact of an Enhanced Recovery after Surgery Protocol on Postoperative
           Outcomes in Cardiac Surgery

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      Authors: Stephanie Bills, Brittany Wills, Samara Boyd, Joseph Elbeery
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundEnhanced recovery after surgery (ERAS) protocols are perioperative care pathways designed to achieve early recovery after procedures. ERAS protocols have shown shortened recovery time, and lower opioid utilization and postoperative complication rates. Evidence to support the use of ERAS protocols is robust, however, minimal data exists in cardiac surgery patients.MethodsThis observational cohort compared adults receiving post-operative care after coronary artery bypass or valve procedures who received an ERAS protocol containing acetaminophen, gabapentin, and methocarbamol to historical controls. The primary outcome of this study was postoperative opioid use during the first 72-hours following cardiac surgery. Secondary outcomes included length of stay, average pain scores 72-hours postoperatively, and incidence of opioid-related complications.ResultsTotal cumulative 72-hour post-operative opioid consumption showed a trend toward reduction in opioid use in patients who received the ERAS protocol vs the historic control group [75.8 mg vs 105.4 mg oral morphine equivalents (P = .09)]. Median postoperative lengths of stay and pain scores were similar between groups. Opioid related complications including constipation and respiratory depression occurred more frequently in the control group compared to the ERAS group [47.7% vs 60.5% (P < .05) and 57.1% vs 62.7% (P < .05) respectively].ConclusionsUse of an ERAS protocol shows a promising trend toward less postoperative opioid use in cardiac surgery patients. Lower rates of opioid-related adverse events, including constipation and respiratory depression, were observed in the ERAS protocol group. This study indicates that ERAS protocols have a potential role for cardiac surgery patients postoperatively.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-08-13T10:26:24Z
      DOI: 10.1177/08971900221119013
       
  • Optimizing Medication Distribution in Automated Dispensing Cabinets:
           Dashboard Implementation and Evaluation

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      Authors: David F. Wai, Rahim F. Merchant, Macarius M. Donneyong
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      PurposeTo determine the impact of a business intelligence dashboard tool to optimize automated dispensing cabinets (ADCs).MethodsA pre-post implementation design was used to evaluate key performance indicators (KPI) before and after the implementation of a dashboard tool to optimize ADCs. Eleven ADCs were optimized in 2 phases according to dashboard recommendations: (1) removal of unused medications over 90 days, (2) adjusting periodic automatic replenishment (PAR) levels, and (3) addition of commonly dispensed medications. The KPI measures that were assessed included inventory cost, no. of stocked medications, stockout percentage, vend to refill ratio, and missing dose messages from nursing. An interrupted-time-series regression was used to quantify the impact of ADCs on the means of measured KPIs.ResultsDifferences in mean distribution of all KPIs, except missing dose, between the pre- and post-ADC periods during the Phase 1 period were statistically significant: inventory cost (54.2 vs 56), stockout percentage (1.55 vs 1.12), vend to refill ratio (6.83 vs 6.14), and missing dose messages (221 vs 229). Only the mean ADC utilization (57.3 vs 64) and missing dose (228 vs 179) were statistically different between the pre- and post-ADC periods in Phase 2. The interrupted-time-series analysis showed that Phase 1 optimization significantly reduced the cost of inventory (β = −$1.238.00, P < .01), no. Stocked medications (β = −8.2, P < .01), percent stockout (β = −.49%, P < .01), vend-to-refill ratio (β = −1.29%, P
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-08-12T12:22:32Z
      DOI: 10.1177/08971900221118159
       
  • Sertraline-Induced Tics: A Case Report and Narrative Review

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      Authors: Ramesh Arasu, Semran Badeshae, Yulia Furlong, Wai Chen
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      This brief report describes the case of a 16-year-old girl who was commenced on sertraline for anxiety and depression, and subsequently developed severe and debilitating motor tics. Cessation of sertraline was associated with the resolution of tics; after this, paroxetine was trialled and well tolerated with good response of targeted symptoms and without re-emergence of tics. A narrative literature review yielded a retrospective observational study and eight single case reports on selective serotonin receptor inhibitor-induced motor tics (three in adolescents and five in adults). Tics are not commonly considered as a side-effect of SSRIs. This case report is novel is several aspects: the tics emergence was immediate whereas previous cases were delayed; the tics symptoms were measured and quantified by a validated scale; a dose-response relationship was observed; to our knowledge, our case was the first adolescent female reported; and finally, paroxetine was well-tolerated as a substitute, although it is unclear whether the observed tics-sparing effect is co-incidental, ideocratic or can be replicated.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-08-09T05:29:21Z
      DOI: 10.1177/08971900221118015
       
  • Comparing Safety and Efficacy of Direct Oral Anticoagulants Versus
           Warfarin in Extreme Obesity

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      Authors: Michael A. Lorenz, Travis W. Linneman
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundLimited clinical data exists regarding use of direct oral anticoagulants (DOACs) in extreme obesity, specifically those ≥140 kg or having a body mass index (BMI) ≥ 50 kg/m2.ObjectiveEvaluate the safety and efficacy of DOACs in extreme obesity.Patients/MethodsA retrospective chart review was performed at a single center of patients aged 18-89 years and weight ≥140 kg or BMI ≥50 kg/m2 receiving warfarin or DOAC therapy. Patients were followed for 1 year from prescribing/study inclusion. The primary outcome was the difference in rates of any bleed (composite of major, nonmajor clinically relevant, or minor bleeding events as defined by International Society of Thrombosis and Haemostasis (ISTH) criteria) between groups. Secondary outcomes included individual components of the composite primary outcome and effectiveness in preventing thrombotic events within 12 months. Post-hoc multivariate analysis evaluated potential predictors of bleeding events within overall patient population.ResultsTwo-hundred eighty-five patients were included, 80 and 205 in the DOAC and warfarin groups, respectively. Rates of any documented bleeding event were comparable in DOAC and warfarin groups (17.5% vs 17.1%, P> .05). No significant difference in rates of minor (P = .067), nonmajor clinically relevant (P = .825), and major (P = 1) bleeding events were observed. Two thrombotic events occurred in the warfarin group compared to none in the DOAC group. Increasing weight was associated with bleeding events in multivariate analysis.ConclusionsThis data did not demonstrate a difference in safety or efficacy outcomes between DOACs and warfarin when utilized in patients with extreme obesity.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-08-08T10:31:07Z
      DOI: 10.1177/08971900221116809
       
  • Improvement in Clinical Outcomes and Access to Care With Pharmacist-Led
           Chronic Care Management Services at a Rural Family Medicine Clinic

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      Authors: Andrew S. Tenpas, Angelina Vascimini, Greg Westwood, Earl Morris, Eric Dietrich, Christina DeRemer
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundChronic care management (CCM) can significantly impact the management of chronic diseases in rural patient populations. To date, few practice models have addressed its impact on clinical outcomes and access to care in rural practice settings.ObjectiveImplement a sustainable pharmacist-led CCM practice model while tracking clinical outcomes and healthcare access at a rural, medically underserved family medicine clinic.MethodsThis study retrospectively examined data from the clinic’s CCM program from October 2020 through May 2021 and included total clinical encounters at three- and 6-months intervals, as well as changes in clinical outcomes like A1c and systolic blood pressure (SBP) at three- and 6-months intervals.ResultsOver an 8-month period, 46 patients were enrolled in pharmacist-led CCM services. Those with a CCM encounter or office visit within 3 months of enrollment showed a mean A1c reduction of 1.07% after 3 months (95% CI −1.70 to −.44, P = .0016), while those with an encounter or office visit within 6 months of enrollment displayed a mean A1c reduction of 1.64% after 6 months (95% CI −2.35 to −.92, P < .001). There was a 73.8% increase in total clinical encounters in the 6 months after CCM enrollment compared to the 6 months preceding it, signifying increased access to care.ConclusionPatients with CCM encounters or office visits within the first 3-6 months experienced statistically significant reductions in A1c. Moreover, total clinical encounters markedly increased in the 6 months after enrollment, allowing for more frequent engagement between ambulatory pharmacists and traditionally challenging rural patients.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-08-07T01:29:59Z
      DOI: 10.1177/08971900221118232
       
  • Evaluating the Role of Pharmacy Technician-Administered Vaccines

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      Authors: Kevin S. Fuschetto, Kunal A. Amin, M. Dave Gothard, Erin M. Merico
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundBefore the COVID-19 pandemic, most states limited administration of vaccines to trained pharmacists and pharmacy interns. In October 2020 due to the public health emergency, the Federal Public Readiness and Emergency Preparedness Act (PREP Act) authorized qualified pharmacy technicians to administer vaccines nationally. Currently available research on the perception of pharmacy technician-administered vaccines is limited.ObjectivesThe primary objective was to evaluate the perceptions of licensed pharmacists and pharmacy technicians regarding pharmacy technician-administered vaccines. The secondary objective was to analyze correlations between demographic data and the perceptions of respondents.MethodsAn anonymous, 24-question survey including 5-point Likert-scale and ranking type questions was distributed using Qualtrics® survey software to licensed pharmacists and pharmacy technicians in the state of Ohio.ResultsTotal of 52,240 pharmacists and pharmacy technicians were invited to participate in the survey, 26,226 viewed the e-mail and 2179 responses were collected, yielding a response rate of 8.3%. Results showed 65.9% (n = 365) of pharmacists and 76.2% (n = 675) of pharmacy technicians agreed that trained pharmacy technicians should be able to administer vaccines post-COVID-19 pandemic.ConclusionLicensed pharmacists and pharmacy technicians in the state of Ohio support the continued administration of vaccines by trained pharmacy technicians fostering the need for legislative change.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-08-06T12:21:18Z
      DOI: 10.1177/08971900221117893
       
  • Evaluating Guideline Directed Medical Therapy in Patients With Heart
           Failure With Reduced Ejection Fraction Post-coronary Artery Bypass
           Grafting

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      Authors: Galen M. Kabulski, Troy Boughner, Thomas W. Szymanski, George G. Sokos, Kazuhiko Kido
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: Limited evidence regarding the use of guideline directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction (HFrEF) undergoing coronary artery bypass grafting (CABG) is available. Objective: The purpose of this study was to characterize prescription of HFrEF GDMT use before and after CABG. Methods: A retrospective analysis of adult patients with an ejection fraction ≤40% undergoing CABG was performed. The primary objective was to evaluate patients receiving HFrEF GDMT, defined as a heart failure beta-blocker (HFBB) and a renin-angiotensin inhibitor preoperatively and postoperatively. Secondary outcomes included dosing, percent of patients on each individual therapy, mineralocorticoid receptor antagonist (MRA) use, and the combination thereof. The follow up period was 1 year. Results: Thirty-eight patients met criteria for inclusion. Prior to CABG, 52.6% of patients were receiving HFrEF GDMT. The prescribing rate of HFrEF GDMT was not significantly higher at any point within 1 year postoperatively (P = .299). The rate of renin-angiotensin inhibitors, HFBB, and aldosterone antagonists use significantly increased from 13.2% preoperatively to 36.8% at 1 year after CABG (P = .022). Doses of individual therapies were not significantly different across all time points preoperatively and postoperatively. Conclusion: HFrEF GDMT use and doses of individual therapies after CABG were not maximized. Collaborative efforts between cardiac surgeons, heart failure cardiologists, and pharmacists could be used to optimize HFrEF GDMT use and dose titration.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-08-05T12:36:08Z
      DOI: 10.1177/08971900221118172
       
  • Risk Factors Associated With Opioid/Benzodiazepine Iatrogenic Withdrawal
           Syndrome in COVID-19 Acute Respiratory Distress Syndrome

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      Authors: Melissa Vu Maffei, Spencer Laehn, Monica Bianchini, Andy Kim
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundMechanically ventilated COVID-19 acute respiratory distress syndrome (ARDS) patients often receive deeper sedation and analgesia to maintain respiratory compliance and minimize staff exposure, which incurs greater risk of iatrogenic withdrawal syndrome (IWS) and has been associated with worse patient outcomes. Objective: To identify potential risk factors and differences in patient outcomes associated with the development of IWS in COVID-19 ARDS patients. Methods: Retrospective analysis of ventilated COVID-19 ARDS intensive care unit (ICU) patients who received continuous intravenous (IV) analgesia and sedation for ≥5 days from March 2020–May 2021. Patients were classified as IWS and non-IWS based on receipt of scheduled oral sedative/analgesic regimens after cessation of IV therapy. Risk factors were assessed in univariate analyses and multivariable modeling. Results: A total of 115 patients were included. The final multivariable model showed: (1) each additional day of IV opioid therapy was associated with an 8% increase in odds of IWS (95% CI, 1.02-1.14), (2) among sedatives, receipt of lorazepam was associated with 3 times higher odds of IWS (95% CI 1.12-8.15), and (3) each 1-point increase in Simplified Acute Physiology Score (SAPS) II was associated with a 4% reduction in odds of IWS (95% CI 0.93-0.999). Conclusion: Prolonged and high dose exposures to IV opioids and benzodiazepines should be limited when possible. Additional prospective studies are needed to identify modifiable risk factors to prevent IWS.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-08-05T06:57:28Z
      DOI: 10.1177/08971900221116178
       
  • Adverse Ocular Effects of Bisphosphonates

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      Authors: Ali Nouraeinejad
      Abstract: Journal of Pharmacy Practice, Ahead of Print.

      Citation: Journal of Pharmacy Practice
      PubDate: 2022-08-04T10:28:23Z
      DOI: 10.1177/08971900221117890
       
  • Evaluation of Patient Experience with Veterans Affairs Clinical Pharmacist
           Practitioners Providing Comprehensive Medication Management

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      Authors: Michael S. McFarland, Michael Tran, Heather L. Ourth, Anthony P. Morreale
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Patient experience is considered an important dimension of health care quality and thus is included as part of the quadruple aim of health care. The VHA Clinical Pharmacist Practitioner (CPP) operates as an advanced practice provider (APP) providing comprehensive medication management (CMM) with authority to initiate, discontinue or modify medication under a scope of practice (SOP). The VHA CPP practices in many different outpatient clinical areas to include but not limited to primary care, mental health, pain management, cardiology, substance use disorder and anticoagulation. While literature regarding the ability of the VHA CPP to increase access and quality of care is well published, very little information exist regarding patient experience with the VHA CPP. We sought to report the patient experience with VHA CPP as measured electronically over 1 year by Veterans. Patient experience surveys were electronically sent to randomly selected Veterans via email to evaluate a recent outpatient healthcare encounter at a VA medical center or outpatient clinic with a CPP with scoring on a Likert scale of 1-5 with 5 being optimal. A total of 743 Veteran surveys were completed for a response rate of 20%. For individual domains of patient experience based on respondent scores of 4 or 5, ease and simplicity were rated at 94.4%, quality 91.9%, employee helpfulness 94.9%, satisfaction 95.0% and confidence/trust 91.9%. Results demonstrate that Veterans’ experience with the CPP in every patient care experience domain was positive with scores ranging from the low to high 90th percentile.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-08-04T09:39:29Z
      DOI: 10.1177/08971900221117892
       
  • Phenytoin Induced Drug Reaction With Eosinophilia and Systemic Symptoms
           Syndrome: A Clinical Case Report

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      Authors: Arshamol Varghese, Aaja Alosious, Rimisha Thomas, Kavya Surendran, Jobin K. Vilapurathu
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially life-threatening hypersensitivity reaction with cutaneous presentation and internal organ involvement. We herein present a case of phenytoin induced DRESS syndrome in a 56- year-old male who presented with high-grade fever and chills, cough with expectoration and generalized maculopapular rash. Laboratory findings revealed eosinophilia, leukocytosis, thrombocytopenia, transaminitis and elevated inflammatory markers. Further clinical, radiological and histopathological assessments confirmed the diagnosis. Phenytoin was discontinued, and patient was started on intravenous dexamethasone, which was later switched to oral prednisone. Rapid resolution of fever, eosinophilia and progressive improvement in skin rash and liver dysfunction was observed. Our report highlights the importance of prompt recognition of DRESS syndrome and the need for a guideline directed therapy for the management of this adverse drug reaction.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-08-04T01:49:22Z
      DOI: 10.1177/08971900221116686
       
  • Understanding the Extent of Polypharmacy and its Association With Health
           Service Utilization Among Persons With Cancer and Multimorbidity: A
           Population-Based Retrospective Cohort Study in Ontario, Canada

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      Authors: Tamara Dean, Anna Koné, Lynn Martin, Joshua Armstrong, Caroline Sirois
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundCancer often co-occurs with other chronic conditions, which may result in polypharmacy. Polypharmacy is associated with adverse outcomes, including increased health service utilization.ObjectivesThis study examines the overall prevalence of polypharmacy (5 or more medications) among adults with cancer and multimorbidity, as well as the association of both minor polypharmacy (5-9 medications) and hyper-polypharmacy (10 or more medications) on high use of emergency room visits and hospitalizations, while controlling for age, sex, and type and stage of cancer.MethodsThis retrospective longitudinal study used linked health administrative databases and included persons 18 years and older diagnosed with cancer between April 2010 and March 2013 in Ontario, Canada. Data on the number of health service utilizations at or above the 90th percentile (high users), was collected up to March 2014 and multivariate logistic regression was used to determine the impact of polypharmacy.ResultsThe prevalence of polypharmacy was 46% prior to cancer diagnosis, and 57% one year after diagnosis. Polypharmacy prior to and after cancer diagnosis increased with the level of multimorbidity, increasing age, but did not differ by sex. It was also highest in persons with lung cancer (52.4%) and those diagnosed with stage 4 cancer (51.3%). Minor polypharmacy increased the odds of being a high user of emergency rooms (1.16; 99% CI: 1.09-1.24) and hospitalizations (1.03; 0.98-1.09) and the odds of high use was greater with hyper-polypharmacy (1.41; 1.33-1.51) and (1.23; 1.17-1.29) respectively.ConclusionPolypharmacy is highly prevalent and is associated with high health service utilization among adults with cancer and multimorbidity
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-07-21T11:56:32Z
      DOI: 10.1177/08971900221117105
       
  • The COVID-19 Vaccine Conundrum: An Assessment of Vaccine Hesitancy Amongst
           Patients at a Federally Qualified Health Center

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      Authors: Letoia R. Clark, Mark Thomas Sawkin, Brittany Lee Melton, Emma Grace Meyer
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundWith three COVID-19 vaccines currently authorized for use in the US, vaccine hesitancy has the potential to sabotage COVID-19 vaccination efforts and be detrimental to overall health outcomes. In order to realize the extent of vaccine hesitancy, an adequate understanding of the role that self-identified barriers and epidemiologic factors may play is timely and important.Objectives The objectives of this study were to 1) determine if there is a relationship between vaccine hesitancy and epidemiologic factors, and 2) identify perceived patient-reported barriers associated with receiving a COVID-19 vaccine.MethodsA written questionnaire was utilized to collect data from eligible patients over a 15-week period between October 2020 and February 2021. A combination of non-parametric tests and descriptive statistics were used to analyze this data.ResultsA majority of patients were either very strongly in support of (28.2%) or very strongly against (29.7%) receiving a COVID-19 vaccine. Notable findings included the comparison of patients with advanced degrees being more likely to get vaccinated (48.1%) to those without advanced degrees (38.8%) (P = .032). There was also a significant difference between races regarding their interest in receiving a COVID-19 vaccine. Blacks were much more likely to answer very strongly against receiving the vaccine (60.9%) compared to Caucasians (22.1%) and Hispanics (30.4%) (P
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-07-21T11:42:23Z
      DOI: 10.1177/08971900221116193
       
  • Use of Concentrated Insulin in the Management of Calcium Channel Blocker
           Overdose: A Case Report

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      Authors: Rachel Rafeq, Matthew Salzman
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      IntroductionHyperinsulinemia-euglycemia therapy [HIE] is a first line therapy recommended in symptomatic calcium channel blocker overdose patients. HIE, particularly if administered in concentrations typically used for glycemic control, would result in a substantial amount of hypotonic fluid administration, which places patients at risk of volume overload. Therefore, it may be beneficial to utilize a concentrated insulin as a strategy to mitigate fluid overload risks. We report the case of a 73 years old, 69.9 kg female, who presented to the emergency department after an accidental ingestion of 70 mg amlodipine and was treated with HIE utilizing a uniquely concentrated insulin infusion.Case PresentationHIE at 10 units/kg/hr. was used for approximately 17 hours. Insulin was changed from a 1 unit/mL concentration to 16 unit/mL. Dextrose 10% infusion was initiated up to a max of 650 mL/hr. and norepinephrine infusion up to a max of 10 mcg/min.DiscussionApproximate fluid requirements from the 16 unit/mL concentration of insulin totaled 1 L as compared to a 1 unit/mL concentration which would have required 17 L, a total savings of 16 L. This savings potentially decreased the risk of cerebral or pulmonary edema associated with fluid overload.ConclusionUse of a concentrated insulin in the setting of a calcium channel blocker or beta blocker overdose provides a unique strategy to mitigate the effects associated with fluid overload.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-07-21T03:45:04Z
      DOI: 10.1177/08971900221116189
       
  • “The Impact of Pharmacists Engaged in Collaborative Practice Agreements
           in the United States”

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      Authors: Theopeste Kerelos, Tricia Gangoo-Dookhan
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      PurposeTo evaluate the role and impact of pharmacists in collaborative practice agreements (CPAs) in the United States.MethodsAn electronic literature review was conducted on studies addressing pharmacists’ involvement in CPAs. Articles included in the review were peer-reviewed studies conducted on adults and published between 2017 and 2022. Articles investigating children were excluded.ResultsOf the articles identified, 8 studies met the eligibility criteria and were selected for the literature review. All of the studies were published between 2017 and 2022 in English in the United States. CPAs were already in place in 7 of the studies with variances due to different healthcare settings and patient populations. The studies evaluated the effect of pharmacist engagement in CPAs on the attainment of clinical and financial goals, satisfaction with pharmacist involvement, and existing barriers to pharmacist engagement in CPAs. Findings showed that pharmacist engagement in CPAs had a positive impact on the attainment of the desired clinical and financial goals, and providers were satisfied with pharmacist involvement. A common barrier to pharmacist involvement was the lack of reimbursement.ConclusionPharmacists engaged in CPAs have a positive impact on healthcare, and there are opportunities for expansion of pharmacists’ roles in CPAs, particularly in non-traditional settings.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-07-19T04:52:06Z
      DOI: 10.1177/08971900221116684
       
  • The Impact of an Antithrombotic Stewardship Program on Heparin-Induced
           Thrombocytopenia Management

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      Authors: John Lee, John Lindsley, Jessica Chasler, Michael B. Streiff, Rakhi Naik, Satish Shanbhag, Kathryn E. Dane
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundAn antithrombotic stewardship program was implemented to reduce IV DTI use and increase fondaparinux and direct oral anticoagulant (DOAC) use for suspected or confirmed Heparin-induced thrombocytopenia (HIT).ObjectivesThis study evaluated the impact of an antithrombotic stewardship program on IV DTI utilization in patients with HIT.MethodsA retrospective analysis of adults receiving IV DTIs or fondaparinux from July 2016 to July 2017 (pre-stewardship) and October 2017 to July 2019 (post-stewardship) was conducted.ResultsThe median duration of IV DTI administration was not significantly different in HIT-negative patients between the pre- and post-stewardship cohorts (1.6 days (25th percentile (p25), 75th percentile (p75): .5, 3.3) vs 1.7 days (p25, p75: .9, 3.9), P = .31). The median duration of IV DTI administration in HIT-positive patients was 9.9 days (p25, p75: 7.6, 21.0) pre-stewardship and 7.3 days (p25, p75: 4.8, 16.5) post-stewardship (P = .18). For HIT-positive patients, the time from HIT diagnosis to discharge was 12.8 days (p25, p75: 8.9, 24.9) and 9.2 days (p25, p75: 4.0, 18.1) in the pre- and post-stewardship cohorts, respectively (P = .07). Fondaparinux and DOAC prescribing rates were 40.7% and 62.2% in the pre- and post-stewardship cohorts, respectively (P = .09). The percentage of patients with no contraindications to IV DTI alternatives receiving these agents increased from 31.2% to 78.6% (P = .01) following stewardship implementation.ConclusionsIntravenous DTI alternative utilization increased significantly after stewardship implementation. Stewardship implementation was associated with a non-statistically significant trend towards decreased IV DTI utilization and decreased length of stay for HIT-positive patients.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-07-18T08:52:42Z
      DOI: 10.1177/08971900221116185
       
  • Conducting Multicenter Residency Research

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      Authors: Christopher Giuliano, Bradley Haan, Claudia Hanni, Tsz Hin Ng, Raymond Yost
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      PurposeConducting well designed pharmacy resident research projects has inherent challenges including inadequate sample size, a lack of time, decreased generalizability, and inadequate research support. A way to overcome these barriers is through conducting multicenter research projects. However, this approach may also bring new challenges. Therefore, the purpose of this article is to provide a general approach for pharmacy preceptors and leaders on implementation of multicenter residency research.SummaryThis article includes a general approach to conducting multicenter research from experienced individuals based upon their successes and failures. A timeline-based format is presented to lay the groundwork for implementation of this approach. Key topics in this paper include establishing a research overview committee, research question development, Institutional Review Board considerations, site recruitment, authorship discussions, resident coordination, protocol development, data collection, manuscript development, and considerations after residency. The approach maintains a critical focus on the individual residents ability to achieve American Society of Health-System Pharmacists accreditation standards for conducting research while operating in a collaborative manner.ConclusionConducting multicenter residency research projects requires a team-based approach and advanced planning. This approach has the potential to improve pharmacy resident project quality.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-07-18T07:41:01Z
      DOI: 10.1177/08971900221116191
       
  • Evaluation of Loop Diuretic Dosing Following Sodium-Glucose Cotransporter
           2 Inhibitor Initiation in Patients With Heart Failure

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      Authors: Brooke M. Trudeau, Larry A. Allen, Sarah J. Billups, Joseph J. Saseen, Scott M. Pearson
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      IntroductionSodium-glucose cotransporter 2 inhibitors (SGLT2is) have demonstrated cardiovascular benefits in patients with heart failure, many of which take loop diuretics. There are no evidence-based recommendations identifying which patients may require loop diuretic dose decreases or how to adjust loop diuretic doses when SGLT2is are initiated. Objectives The main objective of this study was to investigate the frequency and degree of adjustments in loop diuretic doses after SGLT2i initiation in patients with heart failure. Methods In this retrospective evaluation, patients seen in the UCHealth system with a diagnosis of heart failure who were prescribed a loop diuretic before initiation of SGLT2i were identified. We described loop diuretic dose changes at the time of SGLT2i initiation, at 6 months after initiation, and at 1 year after initiation. We also described de-escalation of maintenance medications that can contribute to hypotension at these time points. Data were evaluated using descriptive statistics. Results A total of 100 patients were included. Loop diuretic dose was reduced empirically upon SGLT2i initiation in 2.0% of patients. Reduction of loop diuretic dose within the first 6 months of starting an SGLT2i occurred in 8.0% of patients. From baseline to 12 months after starting SGLT2i therapy, 14.0% of patients had loop diuretic dose reduction. Conclusions Most of our patients with HF did not have change in loop diuretic dose after initiation of an SGLT2i. In patients who did have loop diuretic dose reduction, most occurred within 6 months after starting SGLT2i therapy rather than empirically at time of initiation.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-07-18T06:40:29Z
      DOI: 10.1177/08971900221116187
       
  • Late-Occurring Captopril-Induced Lichenoid Eruption

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      Authors: Chayma Ben Azouz, Hajer Bouraoui, Najet Ghariani, Badreddine Sriha, Raoudha Slim, Chaker Ben Salem
      Abstract: Journal of Pharmacy Practice, Ahead of Print.

      Citation: Journal of Pharmacy Practice
      PubDate: 2022-07-18T06:07:17Z
      DOI: 10.1177/08971900221116181
       
  • Case Report: Possible Serotonin Syndrome in a Patient Taking Kratom and
           Multiple Serotonergic Agents

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      Authors: Sarah T. Eudaley, Shelby P. Brooks, Leslie A. Hamilton
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      IntroductionKratom, an unregulated herbal supplement, has emerged as self-treatment for anxiety/depression. Kratom exhibits inhibition at multiple cytochrome P450 isozymes involved in metabolism of prescription medications, including serotonergic agents. We report a case of possible serotonin syndrome induced by kratom use in combination with prescription psychotropic medications.CaseA 63-year-old male presented with diaphoresis, flushing, aphasia, confusion, dysarthria, right facial droop, and oral temperature of 39.6oC (103.2oF), lactate 2.7 mmol/L, and creatine phosphokinase of 1507 IU/L. Initial differential diagnoses included acute ischemic stroke and bacterial meningitis. Despite partial treatment with alteplase and broad-spectrum antibiotics, symptoms persisted, and subsequent physical exam noted hyperreflexia, clonus, tremors, and temperature of 41.1oC (106oF). Home medications included a chronic regimen for anxiety/depression with bupropion, buspirone, desvenlafaxine, trazodone, and ziprasidone, in addition to kratom. Clinical suspicion for serotonin syndrome led to initiation of cyproheptadine, lorazepam, and cooling blankets. Aphasia, facial droop, and confusion improved after administration of cyproheptadine. Bupropion was restarted during hospitalization; remaining medications restarted at the discretion of the primary care provider.DiscussionRisk of serotonin syndrome with multiple serotonergic agents is well-known. Kratom is metabolized by cytochrome P40 isozymes 3A4, 2C9, and 2D6, and exhibits inhibition at those enzymes, in addition to 1A2. Pharmacokinetic interactions of kratom with prescription serotonergic agents metabolized through these isozymes has the potential to increase systemic exposure of serotonin, potentially leading to serotonin syndrome.ConclusionBecause substances contained in kratom can inhibit metabolism of prescription serotonergic medications, clinicians must be aware of potential development of serotonin syndrome.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-07-16T02:01:26Z
      DOI: 10.1177/08971900221116009
       
  • Pharmacist-Mediated Thyroid-Stimulating Hormone (TSH) Test Guideline
           Monitoring Program- Outcomes of a Retrospective Study In Patients On
           Levothyroxine

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      Authors: Sainul Abideen Parakkal, Faisal Ahmed Hakeem, Hafees Madathil, Raghad Abdulaziz Alabidi, Areej Yahya Alfaifi, Habib Shaker Nemr, Fuad Hamed Al-Ghamdi
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Thirty to sixty percent of individuals taking levothyroxine were either under or overtreated, which leads to organ damage and excess mortality. This study aims to assess the gaps in the “thyroid-stimulating hormone (TSH) test guideline compliance rate” and validate the scope of ambulatory care pharmacist-mediated practice in patients on levothyroxine. At the study site, pharmacists offered patient-centered telephonic counseling to patients on levothyroxine who had been non-compliant with TSH tests for more than a year. A two-month quantitative retrospective analysis of this practice was conducted to assess its impact on TSH lab test adherence and dose modification outcomes. 415 patients met the study’s inclusion criteria who received pharmacist counseling with documented intervention. Pharmacists bridged the significant gap in practice by creating new TSH lab requests with counseling in 81.2% (n = 337) of the study population who did not have TSH lab requests prior to the program. The non-compliance rate population dropped from 79.27% (n = 329) to 17.59% (n = 73) in the study population who had been non-compliant with the TSH test for 13 and 24 months. 74.5% (n = 309) were found to have performed their TSH test after the pharmacist’s intervention. Among 100, 66% (n = 66) patients with abnormal TSH values consulted their physician for advice, of which 60.6% (n=40) had their levothyroxine dose adjusted (χ2=82.702, P < 0.01. The study suggests that pharmacists can significantly mediate between patients and physicians to enhance TSH test compliance and essential dose adjustment in patients prescribed levothyroxine.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-07-15T02:32:44Z
      DOI: 10.1177/08971900221111139
       
  • Incorporation of an Efficient Pharmacist Workflow During the Transition
           From In-Person to Telemedicine Geriatric Clinics in Response to the
           COVID-19 Pandemic

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      Authors: Jeffrey C. Reist, Brent Zahn, Onyeche Oche, Zacariah K. Shannon, Carri Casteel, Richard C. Dobyns, Korey A. Kennelty
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      The COVID-19 pandemic created care continuity challenges for older adults in the ambulatory care setting. Similarly, maintaining the multidisciplinary team concept of geriatric care among healthcare practitioners working from home presented several logistical difficulties. It became apparent there was a need to address these problems to avoid care gaps in this vulnerable population. Realizing that in-person clinics could put vulnerable older adults at increased risk of contracting COVID-19, a workflow was proactively developed to convert a traditional in-person multidisciplinary geriatric clinic to a telemedicine-based model. A video patient encounter option within our electronic health record along with a secure on-line meeting platform was used to maintain a team-based approach to care. This resulted not only in a high level of efficiency in care delivery, but also ensured the safety of older adult patients served by the clinic. This model provides a template for the continued use of telemedicine as a strategy for the care of vulnerable older adults who experience challenges with attending in-person clinics.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-07-04T01:48:13Z
      DOI: 10.1177/08971900221109982
       
  • Student Pharmacist Perspectives of a Remote Ambulatory Care and Community
           Pharmacy Dual-Cohort APPE

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      Authors: Tiffany M. Hatcher, Rebecca R. Schoen, Gale E. Garmong, Autumn L. Stewart-Lynch
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      ObjectiveThe primary aim of the study is to describe the development and implementation of a remote required ambulatory care and required community pharmacy dual-cohort Advanced Pharmacy Practice Experience (APPE) rotation from the student pharmacist perspective. The secondary objective is to identify elements of a remote APPE to integrate into traditional onsite rotations.MethodsAn electronic post-survey was developed to evaluate rotation effectiveness based on the Center for the Advancement of Pharmacy Education (CAPE) outcomes, and to identify rotation attributes to inform future rotations. Students from different graduating classes on rotation between April and June 2020 participated in the survey. Likert-scale, ranked-response, and fixed-answer-choice questions were analyzed using descriptive statistics, and comparisons between cohorts and rotation groups were completed using the Chi-squared statistic (alpha .05). Open-ended questions were assessed for recurring themes. Study was exempted by university’s Institutional Review Board.ResultsTwenty-four of 45 invited students completed the survey (53% response rate). Of the surveyed CAPE outcomes, agreement was highest (95.7%) that the rotation improved students’ abilities within 1.1 Learner, 2.2 Manager, and 4.4 Professional subdomains. Diversity of experiences and topic discussions were elements most frequently identified for inclusion in future rotations.ConclusionStudent feedback was largely positive and indicated the remote APPE rotation experience was meaningful and improved abilities on key CAPE outcomes. Although remote rotations are unique, aspects including diverse learning experiences and preceptor collaboration may be considered for integration into traditional onsite rotations.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-06-27T07:42:43Z
      DOI: 10.1177/08971900221107836
       
  • Initiation of Antipsychotic Treatment for Amphetamine Induced Psychosis
           and Its Impact on Length of Stay

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      Authors: Claire Herbst, Megan O’Connell, Brittany L. Melton, Karen E. Moeller
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      IntroductionA risk of amphetamine use is amphetamine-induced psychosis (AIP). Symptoms of AIP include hallucinations, delusions, and agitation. While AIP may resolve with abstinence from amphetamines, antipsychotics are commonly used despite not being FDA approved. The primary objective of this study was to compare length of stay (LOS) for patients with AIP treated with antipsychotics vs untreated. Secondary aims were to determine antipsychotic prescribed, proportion of patients utilizing as needed doses, time to initiation, and readmissions.MethodsA retrospective chart review conducted at an academic medical center identified adult participants who were diagnosed with AIP, admitted to inpatient psychiatry service, and had a urine drug screen (UDS) positive for amphetamines. Patients were excluded if they were already taking an antipsychotic, had active prescriptions for amphetamine salts, or were in the emergency department for more than 48 hours. Demographics were assessed with descriptive statistics. Length of stay was compared between treatment groups using Kruskal-Wallis. Secondary aims were assessed using chi-square, Mann-Whitney U, and Kruskal-Wallis.ResultsSixty-nine patients were included. Median LOS for patients treated with antipsychotics (n = 35) was longer than untreated patients (n = 34), (5 days vs 2.5 days, P = .001). Type of antipsychotic used and time to initiation of antipsychotic were not found to affect LOS. There was no difference in readmissions rates and positive UDS on readmission between groups.ConclusionThis study found patients with scheduled antipsychotics for AIP had a longer LOS than patients who did not receive scheduled antipsychotics. Future studies are needed to evaluate antipsychotic use in AIP.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-06-22T11:55:23Z
      DOI: 10.1177/08971900221110453
       
  • Adverse Hemodynamic Effects of Dexmedetomidine in Critically Ill Elderly
           Adults

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      Authors: Megan Ingebrigtson, James T. Miller
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: Dexmedetomidine is a currently recommended first-line sedative agent for critically ill patients requiring mechanical ventilation. Recent trials demonstrated no difference in clinical outcomes between patients treated with dexmedetomidine vs usual care, but significantly more hemodynamic adverse effects in the dexmedetomidine group. One subgroup analysis suggested a 90-day mortality benefit in elderly patients, but no distinction was made between groups regarding age when reporting adverse effects. Given potential decreased baroreceptor function in the elderly, adverse hemodynamic effects of dexmedetomidine may impact them more. Objective: To assess the incidence of adverse hemodynamic effects of dexmedetomidine in elderly ICU patients compared to other sedative agents to clarify the role of dexmedetomidine in this patient population. Methods: This was a single-center, retrospective study including mechanically ventilated elderly patients requiring sedative agents for ≥12 hours. The primary outcome evaluated was composite end point of incidence of bradycardia and hypotension. Secondary outcomes included incidence of each adverse event individually, hospital and ICU length of stay, and duration of mechanical ventilation. Results: There was no difference in adverse events between the two groups (58.7% vs 74.1% in the dexmedetomidine vs usual care groups, P =.074). There was no difference in hospital or ICU length of stay. Patients in the dexmedetomidine group were on the ventilator longer than patients in the usual care group with a median of 6 vs 3 days, respectively (P = 0.004). Conclusion: In this single-center, retrospective study dexmedetomidine had a similar incidence of adverse events in elderly patients compare to the usual care group.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-06-22T10:19:14Z
      DOI: 10.1177/08971900221110159
       
  • Current Practice Review in the Management of Acute Respiratory Distress
           Syndrome

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      Authors: Melissa B. Chudow, Melanie S. Condeni, Sanjay Dhar, Mojdeh S. Heavner, Andrea M. Nei, Brittany D. Bissell
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Acute respiratory distress syndrome (ARDS) presents as an acute inflammatory lung injury characterized by refractory hypoxemia and non-cardiac pulmonary edema. An estimated 10% of patients in the intensive care unit and 25% of those who are mechanically ventilated are diagnosed with ARDS. Increased awareness is warranted as mortality rates remain high and delays in diagnosing ARDS are common. The COVID-19 pandemic highlights the importance of understanding ARDS management. Treatment of ARDS can be challenging due to the complexity of the disease state and conflicting existing evidence. Therefore, it is imperative that pharmacists understand both pharmacologic and non-pharmacologic treatment strategies to optimize patient care. This narrative review provides a critical evaluation of current literature describing management practices for ARDS. A review of treatment modalities and supportive care strategies will be presented.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-06-21T08:38:23Z
      DOI: 10.1177/08971900221108713
       
  • Low Dose Antipsychotics for the Treatment of Delirium in Hospitalized
           Elderly Patients and Their Effects on QTc Interval

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      Authors: Shima Heidari, Mona Kargar
      Abstract: Journal of Pharmacy Practice, Ahead of Print.

      Citation: Journal of Pharmacy Practice
      PubDate: 2022-06-20T04:31:16Z
      DOI: 10.1177/08971900221108966
       
  • The Race for COVID-19 Vaccines: The Various Types and Their Strengths and
           Weaknesses

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      Authors: Bahaar K. Muhar, Jeffrey Nehira, Ashim Malhotra, Simeon O. Kotchoni
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      SARS-CoV-2 causes the highly contagious coronavirus disease (COVID-19), first discovered in Wuhan, China, in December of 2019. As of August 21, 2021, over 211 million people have been diagnosed with COVID-19 and 4.42 million people have died from the disease worldwide. The COVID-19 pandemic has adversely affected world economies, global public health infrastructure, and social behaviors. Despite physical distancing and the advent of symptomatic and monoclonal antibody therapies, perhaps the most effective method to combat COVID-19 remains the creation of immunity through vaccines. Scientific communities globally have been diligently working to develop vaccines since the start of the pandemic. Though a few have been authorized for use, the Pfizer vaccine was the first to be given full approval in the United States in August 2021 – being the quickest vaccine to ever be developed. Although several vaccines produced via different approaches are in use, no mortality has been reported thus far from vaccine use. Here, we highlight the latest advances in the development of the COVID-19 vaccines, specifically the lead candidates that are in late-stage clinical trials or authorized for emergency use. As SARS-CoV-2 uses its spike protein to enter a host cell and cause infection, most vaccine candidates target this protein. This review describes the various COVID-19 vaccines - authorized and/or under development - and their composition, advantages, and potential limitations as the world continues to fight this devastating pandemic.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-06-18T10:01:45Z
      DOI: 10.1177/08971900221097248
       
  • Perception of Interprofessional Education among Students Following
           Pharmacy Studies

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      Authors: Alessandro Zaccomer, Francesca Wirth, Liberato Camilleri, Lilian M. Azzopardi
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Introduction:Interprofessional Education (IPE) activities are a first experience of real-world patient care practice for students, where collaboration with different professions is appreciated. Methods and timing of inclusion of IPE are not well-defined, and it is interesting to assess students’ perception on IPE activities.Objective:To assess changes in pharmacy students’ perception of IPE before (t0) and after (t1) an IPE activity.Methods:The ‘Student Perceptions of Interprofessional Clinical Education–Revised 2’ (SPICE-R2) tool was adopted to assess perception of IPE activities in third year pharmacy students, final year pharmacy students and in postgraduate Doctorate in Pharmacy (PharmD) students at t0 and t1.Results:The SPICE-R2 tool was completed at t0 and t1 by 61 students: 12 third year pharmacy students, 13 final year students and 36 PharmD students. A significant improvement between t0 and t1 (P < .05) was measured in the three groups of students for all three subscales of the tool. The largest improvement was observed in the ‘Roles/Responsibilities for Collaborative Practice’ subscale in all three groups of students.Conclusion:Perception of IPE was positively increased in all three student groups. The results could be useful to support the design of IPE activities within pharmacy programmes.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-06-17T06:14:01Z
      DOI: 10.1177/08971900221104254
       
  • Statin-Associated Autoimmune Myopathy: Review of the Literature

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      Authors: Robert Barrons
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      ObjectiveStatin-associated autoimmune myopathy (SAAM) is a rare adverse event characterized by progressive muscle symptoms despite discontinuation, requiring immunosuppressive therapy for remission. The objective of this review was to characterize SAAM, for timely detection, while examining the literature for effective treatment considerations.MethodsPubMed search was conducted from 2010 to 2020 was for relevant case series and studies of at least 8 patients displaying muscle discomfort or weakness, anti-HMGCR antibodies, exposure to statins, and biopsies consistent with SAAM.ResultsThree case series and 3 case cohort studies identified 199 patients with SAAM. Exhibiting a mean age of 63.74 years, patients were more likely Caucasian (81%) and female (1.2X), and required a mean duration of 4.75 years before symptomatic. The presentation involved proximal muscle weakness (94%), myalgias (37%) and dysphagia (23%), accompanied by a mean creatinine kinase of 6383 IU/L. Most patients (57%) required 2 or more immunosuppressive (IMS) agents to achieve 62% remission. After 2 years of treatment, 15% of patients without remission reported symptomatic improvement, while another 12% were refractory to treatment.ConclusionDelayed onset of SAAM greater than 4 years from statin initiation may create a low index of suspicion. However, progression of symptoms beyond 2 months from statin discontinuation and positive anti-HMGCR antibodies requires immunosuppressive agents. Data and expert opinion support use of at least two IMS medications upon diagnosis for a minimum of 2 years. Therapy success depends on timely recognition and initiation of IMS combinations to achieve earlier remission and symptomatic improvement.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-06-16T07:57:53Z
      DOI: 10.1177/08971900211040291
       
  • Intranasal Varenicline: Review of a Novel Formulation for the Treatment of
           Dry Eye Disease

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      Authors: Kimberly L. Zitko, Lauren Ladd, Tyler S. Dougherty
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Objective: To examine the literature pertaining to safety and efficacy of intranasal (IN) varenicline for the treatment of dry eye disease (DED). Data Sources: A literature search of PubMed was performed (1985 to January 2022) using the following search terms: varenicline, OC-01, intranasal, and dry eye. Additional data were acquired from references of identified articles, prescribing information, government databases, and manufacturer website. Study Selection/Data Extraction: All relevant English-language studies were included in this review. Data Synthesis: IN varenicline was FDA approved for the treatment of DED in 2021. IN varenicline has demonstrated a statistically significant improvement in outcomes related to basal tear film production as measured by a Schirmer test score (STS) in data from phase 2 and 3 clinical trials. Safety data from these trials have demonstrated that IN varenicline is generally well tolerated with minimal ocular side effects. The most common side effects reported in the trials were sneezing, coughing, along with throat and nasal irritation. Relevance to Patient care and Clinical Practice: Patients suffering from DED have been traditionally treated with ophthalmic preparations; however, many patients struggle with proper administration of ophthalmic products. IN varenicline stimulates nicotinic cholinergic receptors and basal tear film production through the trigeminal parasympathetic nerve pathway (TPP). There is no evidence to support the long-term remission of DED symptoms with IN varenicline as seen with anti-inflammatory modulators. Conclusions: IN varenicline offers an effective and novel approach to management of DED for patients who desire a non-ophthalmic preparation with a favorable side effect profile.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-06-15T12:20:45Z
      DOI: 10.1177/08971900221108725
       
  • Current Utilization of Antifungal Agents for Intra-abdominal Infections
           Categorized by Patient Risk Factors During Surgical Procedures: A
           Literature Review

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      Authors: Deanna M. Berg, Judianne C. Slish, Murray Wright, Alok D. Gandhi, Mona A. Gandhi
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      The high morbidity and mortality rates associated with invasive fungal infections have led to the overutilization of empiric antifungal therapies. With increasing antibiotic resistance, the careful consideration of prophylactic or empiric antifungal use is critical. The purpose of this review is to evaluate the available literature regarding the current practice of utilizing antifungal agents for intra-abdominal infections based on specific surgical procedures and patient risk factors. Relevant articles were identified through a comprehensive literature search of several databases using the keywords antifungal agents, postoperative period, preoperative care, surgical procedures, and intra-abdominal infections. Only articles that evaluated the use of empiric antifungals for suspected or confirmed intra-abdominal infections and surgical procedures were included in this review. Based on the available literature, antifungal prophylaxis is appropriate in patients who meet the criteria for high-risk invasive candidiasis, kidney or liver transplant recipients, severely-immunocompromised patients with perforated peptic ulcer, peritonitis, and patients on peritoneal dialysis who are failing on a therapeutic antibiotic regimen. We acknowledge that the evidence for using antifungal therapy empirically for all surgical procedures is lacking, and the following review is based on available literature and current guidelines.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-06-15T10:54:34Z
      DOI: 10.1177/08971900221108716
       
  • Alogliptin Induced Stomatitis: An Adverse Drug Event Case Report

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      Authors: Danielle Terry, Andrea V Eads
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: Dipeptidyl peptidase (DPP)-4 inhibitors are commonly used agents to treat type 2 diabetes mellitus (T2DM). Although generally well tolerated, stomatitis has been previously reported as an adverse event with sitagliptin and linagliptin. Stomatitis with alogliptin has not been reported in post-marketing data to date. Objective: To report a case of suspected drug-induced stomatitis in a patient who received alogliptin for T2DM which resolved upon discontinuation of the offending agent. Summary: A 60-year-old male with T2DM began treatment with a DPP-4 inhibitor, alogliptin. After 4 doses of alogliptin, the patient reported inflammation and irritation along the lateral borders of his tongue, along with open fissures and oral ulcerations on the dorsal surface of the mucosa. He was subsequently diagnosed with stomatitis. Patient discontinued alogliptin and reported improvement in symptoms within 48 hours. Lesions re-epithelialized within 4 weeks after cessation of alogliptin. The Naranjo Algorithm was used to assess causality. The total score was 7, which when interpreted, implicates alogliptin as a “probable” cause of the reaction. Conclusion: A causality assessment determined alogliptin was a “probable” cause of stomatitis experienced by this patient. This adverse effect has not been reported with alogliptin to the authors’ knowledge.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-06-15T07:28:12Z
      DOI: 10.1177/08971900221108721
       
  • Design, Implementation, and Assessment Approaches Within an Advanced Human
           Immunodeficiency Virus (HIV) Elective Course

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      Authors: Rustin D. Crutchley, Cheyenne Newsome, Li Wei Chen, Debbie Li, Preeyaporn Sarangarm, Amy Min, Dana Bowers, Renier Coetzee, Kimberly C. McKeirnan
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      IntroductionAn estimated 38 million people are living with human immunodeficiency virus (HIV) worldwide. Pharmacists are well positioned to provide care to patients with HIV, but gaps in HIV education among pharmacists exist. Recognizing the need to educate and prepare future pharmacists, a 2-credit advanced HIV elective course was created for Doctor of Pharmacy students at Washington State University College of Pharmacy and Pharmaceutical Sciences in the United States, and Masters of Clinical Pharmacy students from University of Western Cape School of Pharmacy in South Africa.MethodsCourse topics included diagnosis and treatment of HIV in children and adults, management of common comorbidities, pre-exposure prophylaxis, pharmacogenetic applications, and antiretroviral drug-drug interactions. Course effectiveness was evaluated using student examination results. Student perceptions were evaluated using pre- and post-course self-assessments involving abilities, confidence, and attitudes toward caring for people living with HIV.ResultsStudent pharmacists demonstrated competency in HIV knowledge, demonstrated skills in application to clinical-based scenarios, and reported significantly improved confidence and abilities as well as positive changes in attitudes toward people with HIV.ConclusionThis course contributed to student learning across different student cohorts in an institutional program in the United States including successful execution of distance learning and clinical application for students at a program in South Africa.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-06-15T04:46:44Z
      DOI: 10.1177/08971900221108723
       
  • Patient Experience and Satisfaction with Opioid-Related Screening and
           Intervention in North Dakota Community Pharmacies

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      Authors: Emily Lothspeich, Amy Werremeyer, Sarah Chase, Andrea Huseth-Zosel
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundScreening for patient-level opioid-related risk in the community pharmacy setting has increased patient education about opioids and naloxone distribution, helping to mitigate the impact of the opioid epidemic. However, patient experience and satisfaction with opioid screening and education is unknown. Fear of patient dissatisfaction may limit pharmacists' willingness to implement screening activities.ObjectiveTo report patient experience and satisfaction of a convenience sample of patients undergoing screening and intervention for opioid-related risk as a part of the ONE Program (formerly ONE Rx).MethodsPatients who received ONE Program screening and intervention from their community pharmacist were recruited to participate in a 9 item survey regarding their experience and satisfaction. Results were analyzed by urban and rural location of participants.ResultsUrban (n = 42) and rural (n = 32) patients who completed the survey reported positive experiences namely feeling comfortable with the ONE process (86.5%), the process taking an appropriate amount of time (93.2%) and feeling safer as a result of their pharmacist’s attention to their opioid-related medication risk (86.3%). Urban patients were significantly more likely than rural patients to report positive attitude and behavior changes as a result of the ONE process.ConclusionHigh levels of patient satisfaction and positive experience with the ONE Program screening and intervention process for patient-level opioid-related risks may encourage community pharmacists to more broadly implement such activities.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-06-15T04:40:33Z
      DOI: 10.1177/08971900221109528
       
  • Artificially Elevated Tacrolimus Concentrations Obtained From a Venous
           Catheter Previously Used for Tacrolimus Administration in a Pediatric
           Patient

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      Authors: Magda N. Marschner, Mary M. Chandran, Lindsay G. Colyer
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Intravenous (IV) administration of calcineurin inhibitors, cyclosporine (CsA) and tacrolimus (TAC), has been associated with spuriously high serum concentrations collected from central venous catheters (CVCs) used for medication administration, secondary to reversible adsorption of medication to the catheter. Thus, therapeutic drug monitoring of IV CsA and TAC via CVCs previously exposed to these agents should be interpreted cautiously and ideally avoided. The duration of this effect is poorly characterized and the risk for extension of this effect to unexposed lumens of the same central catheter remains uncertain. We describe a case of a pediatric patient with artificially elevated serum TAC concentrations obtained from previously exposed and unexposed lumens of a central catheter, 27 days after last IV TAC administration.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-06-11T04:07:20Z
      DOI: 10.1177/08971900221107841
       
  • Successful Treatment of Tenofovir Alafenamide-Induced Lactic Acidosis: A
           Case Report

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      Authors: Serena Arnouk, Maureen Whitsett, John Papadopoulos, Zoe Stewart Lewis, Nabil N. Dagher, David M. Feldman, James S. Park
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Nucleoside or nucleotide analogues (NAs) have the potential to cause lactic acidosis by inhibiting DNA polymerase-γ of human mitochondria and impairing aerobic metabolism. Patients may be asymptomatic, have mild non-specific symptoms, or present in multisystem organ failure. There is a paucity of data to guide management of life-threatening lactic acidosis due to NA therapy. Here we describe a case of a 60-year old critically ill male with decompensated cirrhosis secondary to hepatitis B virus (HBV) infection who developed severe lactic acidosis (13.8 mmol/L) 2 days after initiation of tenofovir alafenamide (TAF). All other possible etiologies for the elevated lactate were ruled out. Lactic acidosis resolved rapidly with TAF discontinuation and supplementation with cofactors supporting mitochondrial oxidative phosphorylation, including coenzyme Q10, levocarnitine, riboflavin, and thiamine. This case highlights the ability of TAF to cause lactic acidosis early after therapy initiation, especially in susceptible hosts, and reviews the potential role for cofactor supplementation for drug-induced mitochondrial injury.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-05-28T05:21:14Z
      DOI: 10.1177/08971900221105042
       
  • Administration of Crushed Doravirine via Nasojejunal Feeding Tube in a
           Patient With Treatment-Experienced Human Immunodeficiency Virus

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      Authors: Allison M. Porter, Cassandra R. Baker, Patricia P. Fulco
      Abstract: Journal of Pharmacy Practice, Ahead of Print.

      Citation: Journal of Pharmacy Practice
      PubDate: 2022-05-25T03:27:10Z
      DOI: 10.1177/08971900221104258
       
  • Fluctuating Voriconazole Concentrations during Extracorporeal Membrane
           Oxygenation

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      Authors: Truong Vu, Joel Feih, Janelle Juul
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundPatients requiring extracorporeal membrane oxygenation (ECMO) demonstrate complex drug pharmacokinetics due to alterations in clearance and volume of distribution, necessitating close therapeutic drug monitoring.Case ReportA 19-year-old Caucasian female with no past medical history was transferred from an outside hospital and admitted to the intensive care unit for acute respiratory distress syndrome secondary to a fresh water drowning event. The patient decompensated, requiring veno-arterial ECMO, which was subsequently changed to veno-venous ECMO. She was diagnosed with a Scedosporium apiospermum fungal pneumonia and was started on voriconazole. Throughout the course of antifungal therapy, the patient’s voriconazole concentrations were labile, ranging from subtherapeutic, requiring dose increases to twice the labeled therapeutic dose, followed by subsequent supratherapeutic concentrations, requiring dose reductions.ConclusionOur findings demonstrate how voriconazole drug concentrations can be unpredictable when administered during ECMO and the importance of close monitoring of drug concentrations. More studies are needed to provide sufficient guidance on administering voriconazole in critically ill patients receiving ECMO.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-05-25T02:32:22Z
      DOI: 10.1177/08971900211060959
       
  • Implementation of a Synergistic, Complementary Pharmacy Practice Model for
           an Advanced Heart Failure/Heart Transplant Program

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      Authors: Luke Gormley, Caitlin Mullins, Lynne M. Sylvia
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Study Objective: A pharmacy practice model for an Advanced Heart Failure (HF)/Transplant program was designed to address gaps in medication access, medication education and transitions of care (ToC). Activities specific to these initiatives performed by a four-member pharmacy team (3 pharmacists, 1 specialty technician) are described. Methods: Data were prospectively collected in 2020 for 284 admissions involving a high-risk cohort of advanced HF/transplant patients and a similar cohort seen in an ambulatory HF clinic. Interventions including medication reconciliation, e-prescribing, patient consultation and telephone call backs were performed daily to ensure medication access on discharge and as outpatients, comprehensive medication education on a continuum, and improved ToC. Metrics specific to these interventions and revenue reflecting outpatient prescription volume were quantified. Results: Standardized discharge medication education was provided to 97% of the cohort (n = 275). Of the 51 patients newly transplanted or receiving a left ventricular assist device, 100% had medication access on discharge and received follow-up telephone consultation within 48 hours. ToC was performed on admission (97%), pre-operatively (n = 51; 100%), post-operatively (n = 51; 100%) and on discharge (97%). Outpatient prescription volume increased 42% with net revenue increasing 157%. Conclusion: A pharmacy practice model involving an integrated 4-member team improved medication access and education and allowed for ToC at multiple points in the care process thereby improving medication safety. Collaboration between pharmacists and technicians working in inpatient, outpatient and specialty pharmacy settings is encouraged to provide complementary care to high-risk patients.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-05-22T12:03:55Z
      DOI: 10.1177/08971900221104257
       
  • The Impact of Pharmacists on Telehealth During Transitions of Care: A
           Literature Review

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      Authors: Nicole A Lopez, Theopeste Kerelos, Genevieve Hale
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      PurposeTo provide a review of pharmacists’ impact during transitions of care (TOC) visits utilizing telehealth.MethodsAn electronic literature review was conducted on studies that addressed pharmacists’ impact on telehealth during TOC. Articles included in the review were randomized or observational studies, cohort studies, case series or case reports, literature reviews, or pilot studies conducted on adults. Articles investigating children were excluded from the review.ResultsOf the articles identified, 14 studies met the eligibility criteria and were selected for the literature review. All of the studies were published in English between 2013 and 2021. Most were conducted in the United States of America (n = 12) with 1 conducted in Ireland (n = 1) and 1 in Australia (n = 1). The majority of telehealth monitoring was conducted via phone (n = 8), video conferencing (n = 3), or both (n = 2) in patients’ homes by pharmacists alone (n = 8) while the remaining studies involved telemonitoring by a combination of pharmacy fellows, residents, and/or students. These findings showed that pharmacist intervention in patient care showed improved patient outcomes and goal markers for a variety of health conditions as well as lower rates of 30 day, 60 day, and 90 day hospital readmissions.ConclusionPharmacist involvement in telehealth monitoring had a positive impact on TOC interventions and overall patient outcomes including decreased hospital readmissions and increased patient medication adherence.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-05-22T04:27:59Z
      DOI: 10.1177/08971900221104707
       
  • Students’ Perceptions and Lessons Learned From Virtual APPE Rotations: A
           Multi-Institutional Perspective

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      Authors: Stacey Maravent, Jennifer G. Steinberg, Cynthia Moreau, Andrea Murzello, Jessica Lendoiro, Jennifer Hesly
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Objectives: The COVID-19 pandemic caused disruption in pharmacy experiential learning as clinical practice sites restricted student access to onsite rotations. Therefore, colleges of pharmacy across the country likely included virtual advanced pharmacy practice experiences (APPEs) to fulfill experiential education requirements. The objective of this paper is to evaluate students’ perceptions of virtual APPEs during the 2020-2021 academic year. Methods: Experiential directors and faculty at 3 colleges of pharmacy in the south Florida region developed a survey to assess students’ perceptions of their virtual APPE rotations during the 2020-2021 academic year. Students who took at least one fully virtual APPE rotation were asked about their perceptions of these rotations. Results: A total of 349 students were invited to take the survey and 92 (26.3%) completed the survey. Of these, 77 students (83.7%) completed at least one virtual rotation. These students completed a total of 152 virtual rotations, with elective and ambulatory care rotations being the most frequent. Most students agreed that rotation objectives were clear, and preceptors offered resources needed to be successful during the rotation. Responses regarding engagement during virtual rotations, rotation expectations being met, and rotations expanding students’ knowledge were mixed. Conclusions: Virtual rotations may present unique experiential opportunities for students. Colleges of pharmacy and preceptors can benefit from additional guidance regarding how to incorporate virtual rotations into the experiential curriculum. Best practices for virtual rotations include high frequency of interactions with preceptors, clear objectives and responsibilities, and the use of a rotation calendar.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-05-21T05:49:03Z
      DOI: 10.1177/08971900221104256
       
  • A Retrospective Review of an Inhaler to Nebulizer Therapeutic Interchange
           Program Across a Health System

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      Authors: Megan E. LaCrone, Natalie Buening, Natalie Paul
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundThe hospitals of the Saint Alphonsus Health System (SAHS) have implemented a metered dose inhaler (MDI) to nebulization therapeutic interchange program in which all orders for albuterol/ipratropium and inhaled corticosteroid/long-acting beta agonists (ICS/LABA) MDIs are therapeutically interchanged to nebulizers by pharmacy.ObjectivesThe primary outcome measure is to assess the percent of albuterol/ipratropium and ICS/LABA inhalers therapeutically interchanged to nebulized solutions. Secondary outcomes include assessment of readmission rates, the percentage of patients discharged with the appropriate MDI, and a financial analysis of the implementation of the therapeutic interchange program.MethodsThis retrospective observational cohort study was approved by the system’s institutional review board and conducted between October 15, 2019, and February 15, 2020. Adult patients with history of asthma or COPD admitted to one of the SAHS hosptials with an order placed for ipratropium/albuterol, fluticasone/salmeterol, mometasone/formoterol, or budesonide/formoterol MDIs were eligible for inclusion. Patients were excluded if they were presumed to have or tested positive for COVID-19.ResultsTherapeutic interchanges were successfully completed in 94.3% of the orders included in this evaluation. Discharge discrepancies occurred in 14.3% of orders assessed. No correlation was found between discharge discrepancies and 30-day readmissions. The MDI to nebulized solution interchanges saved $13,908.16 in medication cost in the sample population.ConclusionThe first phase of implementing the SAHS inhaler to nebulizer therapeutic interchange program was operationally and clinically successful. The program is projected to continue to reduce medication waste and provide cost savings for the health system.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-05-21T02:52:06Z
      DOI: 10.1177/08971900221101761
       
  • Cryoprecipitate for Alteplase-Related Hemorrhagic Conversion of Acute
           Ischemic Stroke

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      Authors: Brittany S. Verkerk, Christine Lesch, Samantha Cham, Karen Berger
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: Evidence to support cryoprecipitate for reversal of alteplase-related hemorrhagic conversion of acute ischemic stroke is limited. Guidelines recommend cryoprecipitate as first line treatment, followed by aminocaproic acid as a conditional recommendation with very low-quality evidence. The purpose of this case series was to describe the use of cryoprecipitate for alteplase-related hemorrhagic conversion of acute ischemic stroke. Methods: This was an IRB-approved retrospective case series of adults who received cryoprecipitate for an alteplase-related hemorrhagic conversion of acute ischemic stroke at two comprehensive stroke centers within a large academic medical center. Thromboembolism at 14 days and hemostasis within 24 hours were collected. The outcomes of cryoprecipitate alone vs cryoprecipitate with aminocaproic acid (C + A) were also described. Results: A total of 19 patients were included. Thrombosis occurred in 1/19 (5%) and hemostasis occurred in 4/14 (29%) of evaluable patients. In-hospital mortality was seen in 9/19 (47%) patients. Seventy four percent (14/19) of patients received concomitant blood products other than cryoprecipitate and 63% received a concomitant reversal agent. Thirteen patients received cryoprecipitate alone and six received C + A. Thrombosis was seen in 1/13 (8%) vs 0/6 (0%) and hemostasis occurred in 2/11 (18%) and 2/3 (67%) evaluable cryoprecipitate vs C + A patients respectively. Conclusion: Cryoprecipitate was associated with a low rate of thrombosis and hemostasis for alteplase-associated hemorrhagic conversion of acute ischemic stroke. There was significant heterogeneity in treatment regimens, including the use of and dosing of adjunctive aminocaproic acid and monitoring of fibrinogen levels.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-05-20T03:10:36Z
      DOI: 10.1177/08971900221102116
       
  • Efficacy and Safety of Sitagliptin in the Treatment of COVID-19

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      Authors: Ehab Mudher Mikhael, Siew Chin Ong, Siti Maisharah Sheikh Ghadzi
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: Coronavirus disease 2019 (COVID-19) is associated with a high risk of mortality especially among diabetes mellitus (DM) patients. Effective treatments against COVID-19 can complement the vaccination effort worldwide. Many review articles studied the effects of the dipeptidyl peptidase 4 (DPP-4) inhibitors among COVID-19 patients and found conflicting results. This heterogeneity may be due to different systemic pleiotropic effects of different DPP-4 inhibitors. Sitagliptin appears to be one of the good DPP-4 inhibitors that have antiinflammatory and antithrombotic effect. Therefore, this review assessed the benefits and safety of sitagliptin in the treatment of COVID-19. Methods: A detailed literature review using the electronic databases of Pubmed and Google Scholar was conducted during July and August 2021 to find out studies that published in English language and discussed the role of sitagliptin for COVID-19 patients. Results: 14 articles were eligible and thus included in this narrative review. Nine of these articles agreed to the benefit of sitagliptin in the treatment of COVID-19, while 3 studies considered sitagliptin as non useful or even risky, and one study was neutral in its conclusion towards the usage of sitagliptin in COVID-19. Only one study focused on the safety of sitagliptin and found that it is safe. Conclusion: Sitagliptin has anti-inflammatory, antifibrotic and antiapoptotic properties; such effects may be beneficial in reducing risks of COVID-19. Sitagliptin has good safety and fair benefits to reduce mortality among DM patients with COVID-19. Further randomized clinical trials are needed to confirm these benefits especially among patients without DM.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-05-18T04:21:58Z
      DOI: 10.1177/08971900221102119
       
  • Biosafety Considerations for Viral Vector Gene Therapy: An Explanation and
           Guide for the Average Everyday-Hero Pharmacist

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      Authors: Jill M. Hernandez
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      PurposeAn overview of the multi-faceted biosafety points that must be taken into consideration by pharmacists and pharmacies in order to provide viral vector gene therapy to their practice site.SummaryAs science and medicine evolves, pharmacists and other healthcare workers are continually faced with unique challenges in the workplace. They are expected to be informed and proficient on new therapies and standards of practice, and be able to apply this knowledge appropriately for their patients. One such advancement that seems to be picking up speed in recent years is gene therapy, which is often achieved with the assistance of a viral vector. As these viral vector doses move closer to mainstream medicine, a host of issues and concerns for the pharmacists, nurses, and caregivers that are involved in the process begin to rise to the surface, often rooted in the critical concern: “How do we dispense, utilize, and administer these doses safely'” Unfortunately, there is no singular, concise source of information for addressing biosafety with viral vector products, and guidance must be gathered from a variety of resources in order to mesh together a reasonable working process. Conclusion: While this may seem to be a daunting task, facilities that already meet USP 797 and USP 800 guidelines are well on their way to being ready to provide viral vector doses. By incorporating additional steps and reviewing biosafety specific resources, these sites can easily adapt to provide these new and novel therapies for their patient population.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-05-18T03:16:38Z
      DOI: 10.1177/08971900221104250
       
  • Impact of Pharmacist-Led Interventions to Improve Clinical Outcomes for
           Adults With Type 2 Diabetes at Risk of Developing Cardiovascular Disease:
           A Systematic Review and Meta-analysis

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      Authors: Rahma M. Alabkal, Kristina Medlinskiene, Jonathan Silcock, Anne Graham
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      ObjectiveThe aim of this systematic review and meta-analysis of randomised controlled trials is to evaluate the impact of pharmacist-led interventions on cardiovascular disease (CVD) risk factors among patients with type 2 diabetes.MethodA literature review was conducted according to PRISMA guidelines using 4 electronic databases: Embase, MEDLINE, CINHAL and the Cochrane Central Register of Controlled Trials. We searched for pharmacist interventions among adults with type 2 diabetes and cardiovascular disease in randomised controlled trials from inception to May 2021 in primary care, diabetes clinics and hospitals. The clinical outcomes measured glycosylated haemoglobin (HbA1c), blood pressure (BP) and lipid profile. The non-clinical outcomes included medication adherence, smoking, health-related quality of life and the cost of the intervention. For the meta-analysis, clinical outcomes were pooled with the random effect model in RevMan 5.3. The Cochrane risk-of-bias tool was used to assess the quality of the included studies.ResultsWe retrieved 223 studies,141 of which were included in the review. Ten published articles met the inclusion criteria and were included in the meta-analysis. The pharmacists delivered the interventions alone or collaboratively with other healthcare professionals in hospitals or similar settings. The overall result showed a significant reduction in HbA1c (n = 10; standard deviation in mean value [SDM]: −.53%, 95% CI: −.84, −.23) and systolic BP (n = 10; [SDM]: −.35 mmHg, 95% CI: −.51, −.20) in pharmacist intervention groups. For the non-clinical outcomes, the review revealed variable results from pharmacist intervention compared with those standard care.ConclusionPharmacy interventions provide evidence for pharmacists’ decisive role in diabetes care management and reducing cardiovascular risk factors among adults with type 2 diabetes.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-05-17T10:21:14Z
      DOI: 10.1177/08971900211064459
       
  • Pharmacist-Led Deprescribing for Patients With Polypharmacy and Chronic
           Disease States: A Retrospective Cohort Study

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      Authors: Mabel Chan, Roda Plakogiannis, Abraham Stefanidis, Mandy Chen, Tajinderpal Saraon
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundCurrent literature and practice have demonstrated that pharmacists have an integral role in deprescribing. However, research regarding their impact on patients with chronic diseases is limited.ObjectiveTo assess the impact of a pharmacist-led intervention on deprescribing inappropriate medication for patients with chronic diseases within a four-month study period compared to patients receiving usual care.MethodsThis study was conducted at NYU Langone Health. Patients of the intervention group were referred by a provider and met the criteria of polypharmacy, required chronic disease states management, were nonadherent to medications, had poor health literacy, or required titration for heart failure (HF) guideline directed medical therapy.ResultsA total of 142 patients were reviewed over a two-year period. At the end of the study period, the median number of medications for the two respective groups was similar (11 [4 – 30] vs 11 [2 – 23]). The pharmacist-led intervention had on average one medication deprescribed (m = −1.00, sd = 2.57), whereas the control group had on average .44 additional medications (m = 0.44, sd = 3.32) prescribed. Furthermore, the intervention group presented statistically significant differences (P = 0.046) regarding their diastolic blood pressure after the pharmacists’ intervention (m = 72.69, sd = 11.64). Most importantly, patients with HF presented statistically significant improvement in their ejection fractions after the intervention (m = 41.46%, sd = 19.28%).ConclusionThe pharmacist-led intervention resulted in significant discontinuation of medications for patients in the intervention group compared to those in the usual care group within four-months.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-05-06T12:42:58Z
      DOI: 10.1177/08971900221097246
       
  • Bioavailability of Orally Administered Drugs in Critically Ill Patients

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      Authors: Johanna Forsberg, Emma Bedard, Sherif H. Mahmoud
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Critically ill patients managed in the Intensive Care Unit (ICU) suffer from several pathophysiological alterations due to critical illness resulting in potential changes in the pharmacokinetics of drugs including systemic absorption. Nevertheless, these patients are still given some medications in unadjusted doses thereby putting the patients at a risk for therapy failure. The objective for this study was to summarize the available evidence regarding oral drug absorption in the ICU. A literature search of the databases MEDLINE, EMBASE, and PubMed was conducted on (February 24, 2020). Articles discussing the rate and/or extent of orally administered drugs in critically ill patients were included. A total of 58 studies were found: 17 interventional studies, 33 observational studies (30 prospective, 3 retrospective) and 8 case reports. A total of 43 articles reported altered drug absorption in critically ill patients suggesting the need for alternative measures to facilitate treatment success. The absorption of orally administered drugs may be altered in critically ill patients. Measures for altered drug absorption in critically ill patients were suggested such as holding tube feeding before and after medication administration, increasing doses of orally administrated drugs and using alternate routes of administration.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-05-06T11:06:47Z
      DOI: 10.1177/08971900221100205
       
  • Possible Delay in Symptomatology of a Methadone Overdose in a Patient
           Ingesting an Energy Drink and Dextroamphetamine/Amphetamine

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      Authors: Kyle A. Weant, Gregory A. Hall
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Introduction: Methadone is a mu-opioid agonist with a delayed time to peak concentration that requires an extended period of monitoring following an overdose. Available data suggests that the combination of psychostimulants with methadone may augment antinociception and tolerance to opioids. Case Report: A 26-year-old male (83.9 kg) presented to the ED approximately 1 hour after unintentionally ingesting 200-250 mg of liquid methadone and an energy drink, along with 20 mg of dextroamphetamine/amphetamine prior to the event. Vital signs were: blood pressure (BP), 143/91 mmHg; heart rate (HR), 74; respirations (RR), 16; oxygen saturation 95% on room air. His urine drug screen was positive for amphetamines and methadone. Patient was monitored for 4 hours with no change in status and was discharged home. Approximately 26 hours later patient was found cyanotic and apneic. Patient was given 2 mg of naloxone and awoke with normal mental status. On presentation the patient’s vital signs were: BP, 114/70 mmHg; HR, 114; RR 16; oxygen saturation 94% on 3 liters nasal cannula. During his ED stay, he required 2 doses of naloxone secondary to oxygen desaturation and was admitted to the hospital. His repeat urine drug screen was positive for amphetamines and methadone. The patient was discharged the following day. Discussion: This case illustrates an unintentional methadone overdose combined with the intentional ingestion of an energy drink and dextroamphetamine/amphetamine that possibly masked the toxicity for over 24 hrs. Monitoring parameters for methadone overdoses may need re-evaluation in the setting of the co-ingestion of a stimulant.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-05-06T09:10:57Z
      DOI: 10.1177/08971900221100812
       
  • Stigma by Association: To what Extent is the Attitude Toward Naloxone
           Affected by the Stigma of Opioid Use Disorder'

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      Authors: Samuel O. Adeosun
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      The United States opioid epidemic is fueled by illicit opioid abuse and prescription opioid misuse and abuse. Consequently, cases of opioid use disorder (OUD, opioid addiction), opioid overdose, and related deaths have increased since the year 2000. Naloxone is an opioid antagonist that rapidly reverses opioid intoxication to prevent death from overdose. It is one of the major risk mitigation strategies recommended in the 2016 Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain. However, despite the exponential increase in dispensing and distribution of naloxone, opioid overdose and related deaths have continued to increase; suggesting that the increased naloxone supply still lags the need. This discordance is attributed at least in part to the negative attitude toward naloxone, which is based on the belief that naloxone is only meant for “addicts” and “abusers” (OUD patients). This negative attitude or so-called naloxone stigma is therefore considered a major barrier for naloxone distribution and consequently, overdose-death prevention efforts. This article presents evidence that challenges common assertions about OUD stigma being the sole and direct driving force behind naloxone stigma, and the purported magnitude of the barrier that naloxone stigma constitutes for naloxone distribution programs among the stakeholders (patients, pharmacists, and prescribers). The case was then made to operationalize and quantify the construct among the stakeholders to determine the extent to which OUD stigma drives naloxone stigma, and the relative impact of naloxone stigma as a barrier for naloxone distribution efforts.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-05-04T05:47:55Z
      DOI: 10.1177/08971900221097173
       
  • An Examination of Student Pharmacists’ Perceptions Toward
           Immunization

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      Authors: Michael Danilov, Kira Voyer, Linda M. Catanzaro, Jaime Maerten-Rivera, Karl D. Fiebelkorn
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Introduction: Pharmacists are considered the most accessible health care professionals, especially when it comes to preventative services such as immunizations. Studies have assessed student knowledge and comfort in administering vaccinations immediately after receiving formal training or completing a vaccination clinic experience; however, few have examined students after applying the knowledge to a pharmacy work experience. A survey of student pharmacists regarding these experiences may identify areas that students are less confident in and thus where immunization training could be improved. Methods: A non-validated survey was created in Google Forms and distributed via email from November through December of 2019. The survey was sent to student pharmacists enrolled in one doctor of pharmacy program at a US institution in Western New York who had completed immunization training almost one year prior to the survey. Results: The survey was distributed to 365 student pharmacists. A total of 189 students (51.8%) completed the survey. Student perceptions of providing immunizations were positive overall, with 173 students (91.5%) responding that they agreed or strongly agreed to feeling confident administering intramuscular injections. In contrast, only 110 students (58.2%) agreed or strongly agreed to feeling confident administering subcutaneous injections. Also, 111 students (58.7%) indicated they had not administered an immunization in the 9 months after they had completed their immunization training. Conclusions: Based on this cohort, perceptions are positive overall; however, there is room for continued improvement in training pharmacy students for immunization proficiency as well as increasing the cooperation of pharmacies to allow students to immunize.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-30T02:12:54Z
      DOI: 10.1177/08971900221096993
       
  • Community Pharmacists and Influenza Vaccination: Opportunities and
           Challenges From a Public Health Perspective Journal of Pharmacy Practice

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      Authors: Andréanne Robitaille, Alexandre Chadi, Morgane Gabet, Eve Dubé, Laurence Monnais, Pierre-Marie David
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      ContextIn Quebec, Bill 31, adopted on March 18, 2020, extended vaccination to pharmacists. Despite many advantages, this new practice comes with public health issues reinforced in the context of COVID-19. Therefore, it is essential to understand the opportunities and challenges of the participation of community pharmacists in influenza vaccination, from a public health perspective by (i) describing the year of 2020-2021 influenza vaccination offer, (ii) its opportunities and challenges, and (iii) its impact on the accessibility of this service newly offered by pharmacists to the most vulnerable people.MethodsThis research is a case study from one of the most affected areas by COVID-19 in Canada: Laval. Our method combines documentary analysis and semi-structured interviews with health professionals and public health actors (n = 23). Researchers used a thematic analysis to analyze these results.ResultsMost partners (pharmacists, public health administrators) underlined multiple opportunities of this new practice, ie, pharmacists who can vaccinate, particularly for chronically ill patients. However, structural and strategical challenges remain. More specifically, vaccination seemed to only rely on a “first come, first served” basis, which questions public health objectives of vaccination, such as equitable access.ConclusionThe introduction of new actors, such as pharmacists, represents a major opportunity to improve vaccination coverage and reduce the burden of COVID-19 on the health system. However, this delegation of a public health activity to the private sector undoubtedly requires closer coordination with public health institutions.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-29T05:28:07Z
      DOI: 10.1177/08971900221094932
       
  • Implementation of a Pharmacist-Led, Multidisciplinary Naloxone Patient
           Education Program at an Academic Medical Center

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      Authors: Jennifer Sze, Tsz Chan, Stacy Dalpoas, Catherine Kiruthi, Che’ Matthew Harris, Venkat Gundareddy, Marlena S Parker, Elsen Jacob
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: Opioid related overdoses are a leading cause of death in the United States (U.S). National, state and local initiatives have been implemented to combat the opioid crisis. However, there is a paucity of initiatives that examine the role of comprehensive naloxone education interventions for hospitalized patients. Objective: The aim of this study was to design a multidisciplinary, pharmacist-driven, standardized, patient and product tailored, inpatient naloxone education program (NEP) at a U.S. academic medical center, targeting patients at high risk of opioid overdose, and to examine patients’ retention of education. Methods: This prospective pilot study targeted hospitalized patients who were considered at high-risk for opioid overdose once discharged. Using daily screening methods and established inclusion criteria, we evaluated the impact of implementing a patient-tailored NEP. The primary outcome measures were patient knowledge and awareness of naloxone use. A paired t-test analysis was conducted to assess for improvement in patient naloxone awareness and knowledge. Results: Of ninety-five patients screened, forty-four patients met inclusion criteria and nineteen patients completed naloxone education along with pre- and post-assessments. Patients more accurately completed the assessment, indicating enhanced knowledge about naloxone use and administration, following the naloxone education (4.68 ± .13 vs 3.42 ± .31 out of 5 questions, mean ± SEM; P = .0016). Conclusion: This study found a positive impact on patient knowledge of naloxone use and administration following implementation of a robust and comprehensive NEP.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-29T04:15:28Z
      DOI: 10.1177/08971900221094268
       
  • Students’ Reflections on Learning Experiences in Federally Qualified
           Health Centers

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      Authors: Nira N. Kadakia, Mary E. Nolan, Kimberly S. Illingworth
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Introduction: Final year pharmacy students participate in advanced pharmacy practice experiences in multiple settings. Each practice setting offers different opportunities for student learning and growth. Experiences at Federally Qualified Health Centers (FQHCs) allow student pharmacists to work with patients with unique health and socioeconomic challenges. Objective: The objective of this study was to examine the impact of an ambulatory care rotation at an FQHC on pharmacy students’ learning. Methods: Final year pharmacy students submitted weekly reflections about their experiences at an FQHC using the Driscoll method of reflection. They reflected on activities, examined their effects on learning and growth, and discussed the impact the experiences would have on future practice. Qualitative analysis of students’ reflections was conducted to identify themes related to learning and professional growth. Results: Pharmacy students (N = 11) reflected upon a variety of topics during their rotations at an FQHC. Fifteen themes and 11 sub-themes were identified by the reviewers within 43 reflections. Reflections covered three general areas: types of experiences students participate in at an FQHC, current and future effects of those experiences on student learning or patients’ health, and students’ emotional reactions during the experiences. Conclusions: Student reflections demonstrated that rotation experiences contributed to their growth and learning in communication, collaboration, and empathy. Additionally, students indicated that they gained confidence and skills throughout the rotation. By identifying the meaning students attributed to their learning experiences, reflections can be used to assess rotation activities for modification or continued inclusion.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-27T11:03:52Z
      DOI: 10.1177/08971900221097181
       
  • Pharmacy Students’ Knowledge, Attitudes, and Awareness Toward
           Marijuana Use

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      Authors: Khaled M. Hasan, Olufisayo Oluwafemi, Wilde Ketchatang
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      IntroductionThe aim of this study was to assess the knowledge, attitudes, and awareness of pharmacy students toward marijuana use.MethodsPharmacy students were asked to complete a survey that assess students’ knowledge, attitudes, and awareness toward marijuana use. This study also compared students’ awareness about the harmful effects of marijuana in comparing with alcohol and smoking tobacco. Participants were asked about the possibilities of marijuana-induced cancer and addiction.ResultsTwenty-three percent of pharmacy students reported having used marijuana at some point in their lives. In comparison with tobacco and alcohol, most of the students agreed that tobacco (49%) and alcohol (42%) are more harmful than marijuana (P < .0001). More than sixty percent of students considered marijuana as an addictive substance (P < .02). A 45% of students opposed the possibility of marijuana-induced cancer. Thirty-six percent of the students agreed that marijuana should be legalized for both medical and recreational use with a similar percentage of the students (30 – 32%) believed that marijuana should be legalized for medical use only.ConclusionWith the prevalence of marijuana use and discrepancy among pharmacy students’ responses regarding knowledge, attitudes, and awareness pharmacy schools need to adopt educational activities about the benefits and risks of marijuana.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-27T09:31:13Z
      DOI: 10.1177/08971900221096969
       
  • Efficacy and Tolerability of Twice-Daily Dosing Schedule of Deferasirox in
           Transfusion-Dependent Paediatric Beta-Thalassaemia Patients: A Randomized
           Controlled Study

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      Authors: George Mathew Panachiyil, Tirin Babu, Juny Sebastian, Mandyam Dhati Ravi
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundDeferasirox has proved good efficacy and acceptable safety for the management of thalassaemia patients. However, some patients are unresponsive or intolerant to once-daily administration of deferasirox even at a high dose. The current study evaluated the effectiveness and tolerability of twice-daily dosing of deferasirox among transfusion-dependent paediatric beta-thalassaemia patients.MethodsThis prospective randomized single-blinded parallel study included all transfusion-dependent paediatric beta-thalassaemia patients prescribed with deferasirox, who visit the study site for their regular blood transfusions and follow-up. The enrolled patients were randomized into intervention and control groups by using a simple block randomization method. In the intervention group, the once-daily dosing of deferasirox was changed to twice-daily dosing with the same total daily dose. Whereas, in the control group, the patients continued with the once-daily deferasirox dosing. The serum ferritin levels of both groups were determined on the enrolment day and after 6 months of follow-up.ResultsForty-one patients were included for analysis. A statistically significant mean decrease in serum ferritin levels was detected in the intervention group, while the serum ferritin levels of the control group significantly increased from baseline. The twice-daily dosing of deferasirox was better tolerated by the thalassaemia patients when compared to once-daily dosing.ConclusionThis study concludes that twice-daily dosing of deferasirox with the same total daily dose significantly enhances the iron chelation efficacy and tolerability among transfusion-dependent paediatric beta-thalassaemia patients when compared to once-daily regimen.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-27T07:06:50Z
      DOI: 10.1177/08971900211038301
       
  • Increasing Pharmacy Resident Diversity Through Targeted Recruitment
           Efforts

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      Authors: Corey J. Witenko, Peter Campbell, Amy L. Dzierba
      Abstract: Journal of Pharmacy Practice, Ahead of Print.

      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-25T10:38:00Z
      DOI: 10.1177/08971900221096990
       
  • Paradoxical Excitation Following Intravenous Lorazepam Administration for
           Alcohol Withdrawal – A Case Presentation and Literature Review

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      Authors: Jimmy Gonzalez, Vandan D. Upadhyaya, Zachary T. Manna, Aditya R. Sharma, Jason Christopher, Steven Douedi, Shuvendu Sen
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Benzodiazepines are commonly used medications which are clinically useful towards the treatment of alcohol withdrawal, seizures, anxiety disorders, among other indications. Benzodiazepine use is also known to cause the rare phenomenon of paradoxical excitation whose mechanism has many postulated theories. We report this rare presentation of paradoxical excitation with the use of lorazepam in a 50-year-old male being treated for alcohol withdrawal. We also review the underlying pathophysiology, pharmacology, and current literature as it relates to this excitation. An inability to recognize this adverse effect and to appropriately withhold the agent may adversely affect a patient’s course of treatment in the inpatient setting.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-25T01:17:47Z
      DOI: 10.1177/08971900221097182
       
  • Clinical Pharmacist Led Medication Reconciliation Program in an Emergency
           Department Observation Unit

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      Authors: Stephanie Cardinale, Tajinderpal Saraon, Nawang Lodoe, Abdullah Alshehry, Melanie Raffoul, Christopher Caspers, Etty Vider
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      ObjectivesMedication reconciliation is the process of comparing a patient’s hospital medication orders to all of the medications that the patient has been taking prior to admission. The primary aim of this study was to evaluate the effectiveness of pharmacist-led medication reconciliation in reducing ED visit rates. The secondary aim of this study was to evaluate if a clinical pharmacist reduces medication errors in an ED observation unit (OBS).MethodsThis was a retrospective, IRB approved, chart review conducted at New York University Langone Health-Tisch Hospital. The study defines the year before a clinical pharmacist was present on the unit (July 5, 2016 through July 4, 2017) as the control group and the first year a clinical pharmacist was present on the unit (July 5, 2017 through July 4, 2018) as the intervention group. The primary endpoint was 30-day ED re-visits. The secondary endpoints were 60-and 90-day ED re-visits, number, type and severity of medication history and reconciliation discrepancies.ResultsThe primary endpoint of 30-day ED visits occurred in 153 patients in the no pharmacist group and 88 patients in the OBS clinical pharmacist group (19.1% vs 9.9%, P < .00001). The secondary endpoint of 60- day ED visits occurred in 53 patients in the no pharmacist group and 39 patients in the OBS clinical pharmacist group (8.2% vs 4.9%, P = .01). The secondary endpoint of 90- day ED visits occurred in 31 patients in the no pharmacist group and 26 patients in the OBS clinical pharmacist group (5.2% vs 3.4%, P = .01).ConclusionThe benefits of having a clinical pharmacist perform medication reconciliation are highlighted by the reduction in ED visits, cost savings, and the prolific amount of errors corrected.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-24T08:59:25Z
      DOI: 10.1177/08971900221091174
       
  • Prevalence, Microbial Etiology and Risk Factors Associated With Healthcare
           Associated Infections Among End Stage Renal Disease Patients on Renal
           Replacement Therapy

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      Authors: Saad Hanif Abbasi, Raja Ahsan Aftab, Pauline Siew Mei Lai, Soo Kun Lim, Ruwaida Nur Zainol Abidin
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      End stage renal disease (ESRD) patients on renal replacement therapy (RRT) have an increased risk of morbidity and mortality due to healthcare associated infections (HCAIs). The aim of this study is to determine the prevalence, microbial etiology, and risk factors associated with HCAIs among ESRD patients on RRT. A multicenter, retrospective study was conducted from June to December 2019. ESRD patients with minimum of 6 months on RRT were included, while pregnant patients and patients
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-24T05:06:15Z
      DOI: 10.1177/08971900221094269
       
  • Barriers to COVID-19 Vaccines and Strategies to Improve Acceptability and
           Uptake

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      Authors: George T. Nawas, Rana S. Zeidan, Cole A. Edwards, Rania H. El-Desoky
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      The COVID-19 pandemic has had a significant impact on communities across the United States (US). Three vaccines have now been granted Emergency Use Authorization by the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) for use in the US. However, barriers to vaccination exist, some of which are well documented in the literature, including lack of knowledge, fear, accessibility, mistrust in the healthcare system, and systemic and operational obstacles. Vaccine hesitancy in the US could potentially hinder all the efforts and resources being used to beat COVID-19, which has resulted in more than 594 000 deaths in the US per the CDC as of early June 2021. In order to overcome this pandemic, vaccine distribution and uptake is crucial. Pharmacists play a crucial role as healthcare providers as they can dismantle vaccine hesitancy and make an outstanding impact on the efforts to overcome this pandemic.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-24T03:02:45Z
      DOI: 10.1177/08971900221081621
       
  • A Review of Push-Dose Vasopressors in the Peri-operative and Critical Care
           Setting

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      Authors: Kaitlyn L McPherson, Nicole L Kovacic Scherrer, William B Hays, Alexandra R Greco, Jeffrey M Garavaglia
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      During hospitalization, the risk of hypotension and associated sequelae remain important considerations for patient outcomes. The use of push-dose vasopressors (PDP) outside of the operating room has increased in recent years to combat the negative effects of hypotension. This narrative review evaluates the utility of PDP in its traditional perioperative setting as well as in areas of increasing use such as the emergency department and intensive care unit. Articles evaluating PDP highlight successful increases in blood pressure with all agents but differ in rates of adverse events and most lack direct comparison of PDP agents in regard to safety and efficacy. Agents utilized as PDP, including epinephrine, phenylephrine, norepinephrine, vasopressin, and ephedrine vary in mechanism of action, onset of action, and duration of action. These variations in pharmacology along with published literature may lead to differences in the preferred PDP for various clinical scenarios. Many adverse events associated with PDP have been due to dosing errors highlighting the importance of education surrounding the use of these agents. Additional research is necessary to further elucidate the risks and benefits of PDP in clinical practice, and to determine which PDP is truly preferred. Careful consideration should be given when determining the appropriateness of this administration method of vasopressors in various clinical scenarios.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-23T06:35:50Z
      DOI: 10.1177/08971900221096967
       
  • The Use of Hydrocortisone, Ascorbic Acid and Thiamine in Patients with
           Sepsis and Septic Shock – A Systematic Review

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      Authors: Kunkun Wang, Ling Yin, Yang Song, Mengqi Zhang, Yun Lu, Shan Wang
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: Sepsis and septic shock are associated with enormous mortality and health care burden. Since the study of Marik et al suggested mortality benefit, there has been great interest in evaluating the role of hydrocortisone, ascorbic acid and thiamine (HAT therapy) in sepsis and septic shock. Purpose: The objective of this article is to review current literature of using HAT therapy in sepsis and septic shock, and discuss the findings in hospital mortality, change in 72 hr SOFA score, other outcomes, and the study limitations. Research Design: Three databases (PubMed, Embase, and Cochrane) were screened using predefined search terms ascorbic acid, vitamin C, thiamine, vitamin B1, hydrocortisone, sepsis, septic shock. Study Sample: Data extracted from eligible studies include authors, publication year, sample size, study design, intervention, outcome measures and study results. Each study was reviewed critically. Results: Among 11 studies included in this literature review, 3 studies reported HAT therapy was associated with mortality benefit, 1 reported hospital mortality was significantly higher in HAT group and the rest of studies didn’t reach statistical significance in mortality analysis. Significant improvement of secondary outcomes, although not consistently, were reported. Conclusions: In conclusion, HAT therapy has demonstrated a good safety profile and potential benefits in management of sepsis and septic shock. Further research is required to confirm these findings.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-23T04:13:11Z
      DOI: 10.1177/08971900221097193
       
  • Association Between Sedative Medication Administration and Delirium
           Development in a Medical Intensive Care Unit

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      Authors: Nicholas D. Franz, Cesar Alaniz, James T. Miller, Nicholas Farina
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundDelirium develops frequently in intensive care unit (ICU) patients. Societal guidelines have suggested that benzodiazepines may cause delirium. This study investigates if a change in sedation administration use over time is associated with changes in delirium incidence.MethodsThis was a retrospective cohort study conducted over a 4 year time period in a medical ICU. All data was abstracted from a local data warehouse. The primary outcome of the study was the association between annual cumulative benzodiazepine use and incidence of delirium during the study period. Data was analyzed using descriptive characteristics and Spearman’s correlation coefficient. Additionally, multivariate logistic regression was performed to identify independent risk factors for delirium development.ResultsFrom 2015 to 2018, annual total benzodiazepine administration decreased from 62,215 mg to 18,105 mg lorazepam equivalents (p =
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-23T01:01:29Z
      DOI: 10.1177/08971900221096978
       
  • Initiating Primary Care Services when the World Is Paused: Lessons for
           Pharmacists in the Post–COVID-19 Era

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      Authors: Joseph A. Nardolillo, Natalie Rosario, Vivian Cheng, Alison M. Lobkovich
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      The COVID-19 pandemic impacted primary care and required pharmacists to adapt when implementing primary care services. Many lessons learned through this process are applicable in the post-pandemic era. First, primary care pharmacists must prepare for an ever-changing role and communicate with stakeholders to align with shifting institutional priorities. Additionally, designing a workflow given limited staffing and in-person communication require flexibility for scheduling and referral processes. Proactive outreach and communication via virtual platforms may be used to build trust in place of in-office interactions with providers. Lastly, fostering relationships with patients is essential to the success of the service and often requires creation of patient-centered goals to account for personal barriers. Many pandemic obstacles are transient; however, telehealth, virtual communication, and the subsequent lessons learned in adaptability, creativity, and flexibility when building a clinic practice are everlasting.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-20T04:23:28Z
      DOI: 10.1177/08971900221087934
       
  • A Real World Perspective of PARP Inhibitor Use in Gynecological Cancer
           Patients

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      Authors: Chung-Shien Lee, Jennifer Hernandez, Connie Liang, Ashley Leung, Dimitre G. Stefanov, Kit Cheng, Veena John
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      IntroductionOver the last few years, targeted therapy has become the mainstay maintenance treatment of patients with ovarian cancer including patients with BRCA1/BRCA2 mutations. Poly ADP ribose polymerase inhibitors (PARPi) are effective in the treatment of patients who are in complete or partial remission. PARPi are known to cause hematological adverse events (AEs), but have not been compared directly to each other.ObjectivePrimary objective was to compare the incidence of hematological and non-hematological AEs associated with the use of PARPi.MethodsThis was a single institution, retrospective study evaluating patients who were treated with PARPi for ovarian cancer from January 2017 to October 2020. Patients were stratified according to which PARP inhibitor they received.ResultsNinety-two patients were included in final analysis. Thirty-one (33.7%) patients received niraparib and 61 (66.3%) patients received olaparib. Median age of patients were 64.3 (range, 33.8 to 92.3) years, 66 (71.7%) were white, and 84 (91.3%) had an ECOG PS of 0/1. Patients in the niraparib group experienced a higher rate of hematologic AEs, with 11 (35.5%), 20 (64.5%), and 18 (58.1%) experiencing neutropenia, anemia, and thrombocytopenia, respectively. Eight (13.1%), 24 (39.3%), and 16 (26.2%) patients in the olaparib group experienced neutropenia, anemia, and thrombocytopenia, respectively.ConclusionThis single institution retrospective study outlines the hematological toxicities observed between two PARPi. Our results suggested that niraparib tended to be associated with a higher risk for hematologic toxicities than olaparib. Anemia was the most common hematologic toxicity which was consistent with what has been widely documented in the literature.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-19T05:51:44Z
      DOI: 10.1177/08971900221088793
       
  • Impact of Patient Assistance Programs on Hospital Visits in Patients With
           Chronic Obstructive Pulmonary Disease or Asthma

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      Authors: Brooke N. Gallman, J. Whitney Huddleston, Marianne E. Ray, Susan E. Smith
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundThe inability to afford medications can lead to nonadherence and uncontrolled disease states. As a result, patients may require an increase in acute healthcare utilization to control potential complications. Qualifying patients can apply for patient assistance programs (PAPs) through various manufacturers to receive medications at little to no cost. Having consistent access to necessary medications can increase adherence and decrease acute care utilization. The purpose of this study was to evaluate the impact of PAP enrollment on healthcare utilization in patients with asthma or chronic obstructive pulmonary disease (COPD).ObjectivesThe primary objective was to compare the number of ED visits and hospitalizations before and after PAP enrollment. Secondary objectives were the estimated ED and hospitalization costs before and after PAP enrollment.MethodsThe retrospective, observational cohort study included patients of Piedmont Athens Regional Community Care Clinic who received medications for asthma or COPD through PAPs from January 2018 to March 2019.ResultsA total of 269 patients were screened, and 56 patients met inclusion criteria. Of these, 28 patients had at least one hospital encounter. Primary objective resulted in cumulative number of ED visits decreased from 54 to 7 (P < 0.001) and cumulative hospitalizations decreased from 13 to 0 (P < 0.001). Secondary objective showed patients with at least one hospital encounter had a median cost decrease from $4683 to $0 (P < 0.001). The median hospital acquisition cost per person decreased from $351 to $0 (P = 0.002).ConclusionA decrease in use of acute healthcare services was observed after PAP enrollment. This was associated with cost savings for patients and the healthcare system.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-16T06:21:21Z
      DOI: 10.1177/08971900221087136
       
  • Evaluating Impact of Implementing Order Questions on Appropriate
           Prescribing of Tolvaptan

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      Authors: Ashton D. VanDyke, Nicholas Wolters
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundTolvaptan poses a significant risk to patient safety due to its risk of overcorrection of hyponatremia, and its cost-effectiveness is not well established. Kettering Health implemented order questions into Epic in 2019 to drive appropriate use of tolvaptan.ObjectiveThe primary objective was to determine the impact of implementing order questions on appropriate use of tolvaptan. The secondary objectives were to determine if providers are adhering to the order questions meant to ensure appropriate use, to identify if there is provider variance across the network constituting a higher proportion of use outside of network recommendations, and to look at patients with multiple orders for tolvaptan and discern if dose titration was appropriate based on sodium levels.MethodsThis study was a retrospective chart review of all patients who received a dose of tolvaptan from 7/3/2019 to 10/15/2020.ResultsFrom July 2019 to October 2020, 211 patients received tolvaptan for hyponatremia, resulting in 598 administrations. Use of urea powder or fluid restriction preceded 248/586 (42.3%) tolvaptan administrations and the patient’s sodium level was < 125 mEq/L or 125–135 mEq/L with documentation of symptoms for 261/586 (44.5%) of the administrations. Medication safety concerns related to monitoring sodium levels were also identified.ConclusionsWhile tolvaptan use did significantly decrease in Kettering Health since the implementation of order questions, the answers to the questions displayed substantial variability. Further opportunity exists for directing appropriate use of tolvaptan within Kettering Health and additional emphasis should be placed on safe use of this medication.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-16T02:22:19Z
      DOI: 10.1177/08971900221087079
       
  • Droxidopa in the Management of Hepatorenal Syndrome

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      Authors: Andrea Bejjani, Youqi Zhang, Allison Behrens, Brian Murray, Neil Shah
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      PurposeHepatorenal syndrome (HRS) is renal dysfunction associated with the hemodynamic consequences of advanced liver disease and cirrhosis. HRS is associated with a high mortality, and there remain high failure rates with first-line therapy aimed at improving perfusion. We report the use of droxidopa, an oral norepinephrine precursor, to aid in the management of HRS-AKI refractory to first-line therapy.SummaryA 51-year-old Caucasian male with alcohol-related cirrhosis presented with 1-week history of pre-syncope and falls. He was found to have acute kidney injury meeting diagnostic criteria of HRS based on absence of identifiable contributing factors. After no response to volume expansion, medical management was initiated with midodrine and octreotide and eventually escalated to norepinephrine intravenous infusion. The patient’s renal function and urine output improved initially on norepinephrine, but worsened when attempting to wean to a suitable outpatient regimen, becoming dependent upon norepinephrine. On day 13 of hospitalization, droxidopa was initiated at a dose of 100 mg three times daily and titrated to a dose of 400 mg three times daily. Norepinephrine infusion was weaned and discontinued on day 16 of hospitalization. The patient remained hemodynamically stable and was able to be discharged on droxidopa 400 mg three times daily, midodrine 20 mg three times day, and octreotide 200 mcg three times daily.ConclusionDroxidopa, an oral norepinephrine precursor, presents a novel adjunctive agent for management of HRS refractory to first-line medical management.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-15T09:28:21Z
      DOI: 10.1177/08971900221087974
       
  • Impact of Glucagon-Like Peptide 1 Receptor Agonists in Patients with
           Hemoglobin A1c of 9% or Greater

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      Authors: Victor Tran, Henry Tran, Shaban Demirel, Nathaniel Thompson-Moore
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundGlucagon-like peptide-1 receptor agonists (GLP-1 agonists) are effective hemoglobin A1c (HbA1c) and weight-lowering agents. The treatment effect is unknown in patients with HbA1c of 9% or greater.ObjectiveThe purpose of this study was to evaluate glycemic control and weight loss after adding a GLP-1 agonist in patients with a baseline HbA1c of 9% (75 mmol/mol) or greater.MethodsA single-health system retrospective chart review screened adults with type 2 diabetes mellitus with a baseline hemoglobin A1c of 9% (75 mmol/mol) or greater and were prescribed a GLP-1 agonist for eligibility. The primary outcome assessed was the change in HbA1c from baseline to the first HbA1c check. Secondary outcomes included change in weight (kg) from baseline to the first HbA1c check.ResultsThree hundred sixty-two patients were screened of which 151 (41.7%) were included in the final analysis. The mean change in HbA1c from baseline to first HbA1c check for all participants was −2.1% (95% CI: −2.3% to −1.8%; P < .001; −23 mmol/mol [95% CI: −25 to −20 mmol/mol]). The mean change in weight from baseline to first HbA1c check was −2.0 kg (95% CI: −2.6 kg to −1.4 kg; P < .001).ConclusionIn patients with type 2 diabetes mellitus with a baseline HbA1c ≥ 9%, GLP-1 agonist initiation resulted in a significant reduction of both HbA1c and weight compared to baseline. Large, prospective, multisite studies are needed to confirm findings of this retrospective study.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-15T04:20:23Z
      DOI: 10.1177/08971900221087933
       
  • More than Drug Fever: Dexmedetomidine-Induced Hyperthermia in a Critically
           Ill Patient

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      Authors: Christian L. Kressin, Eric Bensadoun, William James, Blair Lawless, Brittany Kellum, Alexander H. Flannery
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Dexmedetomidine is a selective alpha-2 adrenergic agonist utilized for sedation in critically ill patients. We present the case of a morbidly obese critically ill patient who experienced profound hyperthermia, with a maximum temperature of 41.4°C, hours after starting a dexmedetomidine infusion that was otherwise not explained by her clinical diagnoses. The hyperthermia resolved hours following cessation of the infusion. Dexmedetomidine was assessed as probable in terms of causing this adverse effect. Dexmedetomidine may be associated not only with low-grade fever, but as demonstrated in our case, it may be associated with significant temperature elevations requiring cessation of therapy to restore normothermia.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-14T09:25:40Z
      DOI: 10.1177/08971900221087948
       
  • Simulation-Based Training to Improve Clinical Pharmacist Self-Efficacy in
           the Management of a Rapidly Decompensating Patient

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      Authors: Shane Salimnejad, Jennifer M. Schultheis, Michael D. Wolcott, Jennifer D. Mando-Vandrick, Siyun Yang, Hui-Jie Lee, Bridgette L. Kram
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundThe optimal training method to prepare pharmacists as an integral rapid response team or cardiopulmonary arrest responders is poorly described. This study assessed the utility of simulation-based training (SBT) as a training technique for clinical pharmacists.ObjectiveThis study aimed to determine if attending SBT is associated with an improvement in self-efficacy.MethodsThis single-center, prospective, interventional cohort study offered three simulations to clinical pharmacists over the course of seven months at a 957-bed quaternary care academic medical center. Pharmacists who participated in at least one simulation were categorized in the intervention group and were compared to pharmacists who did not attend a simulation. All participants were asked to complete a 19-question self-efficacy survey in the form of a 100-point scale, a 15-question multiple-choice knowledge assessment, and a perception survey in the form of 4-point Likert scale administered at baseline and following the conclusion of the SBT.ResultsForty-four clinical pharmacists participated; 20 in the intervention group and 24 in the control group. Median change in self-efficacy score improved significantly in the intervention group compared to the control group (14.3 vs 2.3, P = .009). Median change in perception score improved significantly (2 vs 0, P = .046). Knowledge score did not change significantly from baseline.ConclusionSimulation-based training improved clinical pharmacist self-efficacy and perceptions in the care of rapidly decompensating patients. These findings support SBT as a viable modality of training clinical pharmacists for the management of rapidly decompensating patients.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-14T07:41:21Z
      DOI: 10.1177/08971900221088784
       
  • Cost-Effectiveness of Sacubitril–Valsartan Compared to
           Angiotensin-Converting Enzyme Inhibitors in Patients With Heart Failure
           With Reduced Ejection Fraction

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      Authors: Ratih P. Febrinasari, Stefanus E. Putra, Muhammad Hafizhan, Ari N. Probandari
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      ObjectivesThe goal of this study was to compare cost-effectiveness of sacubitril/valsartan with angiotensin-converting enzyme (ACE) inhibitors for treating chronic heart failure patients with reduced ejection fraction (HFrEF) from the published articles and explore the methodology applied in the studies.MethodsSystematic research was conducted in February 2021 using PubMed, Cochrane, and EBSCO. A combination of MeSH terms of “cost-effectiveness analysis,” “heart failure with reduced ejection fraction,” “sacubitril valsartan,” and “angiotensin converting enzyme inhibitor” was employed. The review selected for articles published in the last five years in English.ResultsA total of 15 studies were included in this review. We found that these studies had been conducted in 12 different countries. The United States had the greatest number of publications (5), followed by the Netherlands (2). The study method most used was the Markov decision model (73%). Almost all studies produced ICERs and QALYs that were numerically high.ConclusionsThe use of sacubitril/valsartan associates with longer life expectancy and incremental cost-effectiveness ratio than angiotensin-converting enzyme inhibitors.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-14T05:51:13Z
      DOI: 10.1177/08971900221087106
       
  • Design and Implementation of Tech-Check-Tech Programs in North Dakota
           Pharmacies

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      Authors: Diane Halvorson, Heidi N. Eukel, Melissa Gilbraith, Ty Schaper, Donald R. Miller
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundTech-check-tech (TCT) programs in pharmacies are beneficial in facilitating a transition from fee for service dispensing tasks to advanced patient care, but they are underutilized.ObjectiveTo describe the design, implementation, and evaluation of a transferable TCT program in several North Dakota pharmacies, with the goal of facilitating future efforts in other states.MethodsWe developed a universal TCT implementation toolkit, recruited 6 pharmacies to implement it, developed an educational program for the pharmacies, and worked with the pharmacies over a year to assess success of the program. Pre- and post-implementation surveys assessed pharmacist and technician responses in regards to program effectiveness. Four outcomes were measured, and included pharmacist’s time savings, descriptive comments on changes in workflow, incidence of errors and near misses, and barriers to implementation.ResultsThe implementation of TCT was unanimously perceived as successful and increasing efficiency in the post-site surveys completed by pharmacists. All 13 technicians who participated in the post-survey indicated the methods and materials used for training were sufficient and appropriate. The most commonly cited barrier to implementation of TCT stated by technicians was incorporating TCT into their current workflow. No dispensing errors which resulted in patient impact occurred throughout the duration of this study.ConclusionsA TCT implementation template provided a successful framework for TCT in various pharmacy settings and can serve as a model for other pharmacy settings, states, or regions.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-13T09:41:30Z
      DOI: 10.1177/08971900221088787
       
  • Gabapentin and Opioids Utilization in Patients With Diabetic Neuropathy
           Enrolled in Medicare (2012–2016): A Cohort Study

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      Authors: Swarnali Goswami, Sujith Ramachandran, Manvi Sharma, Marie Barnard
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      This retrospective cohort study describes the utilization of opioids and gabapentin among patients with diabetic neuropathy who were gabapentin and opioid naïve, and assesses predictors of concomitant use of opioids and gabapentin. Using Medicare claims data (2012–2016), 22 037 patients were identified, of whom 23.42% (N = 5161) initiated opioids without concomitant gabapentin, 4.56% (N = 1004) initiated gabapentin without concomitant opioids, and 3.87% (N = 852) had concomitant use of gabapentin and opioids 12 months following their index date (date of earliest diagnosis). Concomitant gabapentin and opioid use were more common for lower doses of both drugs and for 15 days or more cumulatively. Compared to individuals aged 65–74, those aged 75–84 (OR: .759; 95% CI: 0.653–.882) or ≥ 85 years (OR: .586, 95% CI: 0.462–.743) had lower odds of concomitant use. People residing in the Northeast had lower odds of concomitant use, compared to those residing in the South (OR: .646 95% CI: 0.535–.779). Females compared to males (OR: 1.185, 95% CI: 1.027–1.367), people with higher Charlson’s Comorbidity Index (CCI) scores (OR: 1.085, 95% CI: 1.037–1.135) or those having anxiety (OR: 1.462, 95% CI: 1.131–1.889) had higher odds of concomitant use. Concomitant prescriptions of opioids and gabapentin were more common for longer durations, indicating the need for interventions aimed at minimizing this prescribing practice.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-13T07:40:14Z
      DOI: 10.1177/08971900221087119
       
  • Off-Label Use of Ceftazidime-Avibactam in a Premature Infant With
           Multidrug-Resistant Klebsiella pneumoniae Infection: A Case Report

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      Authors: Allan da S. Nascimento, Marcos F. Passaro, Priscilla S. de S. Silva, Sérgio F. Rodriguez, Marilene K. Martins, Stefane Cristina P. Oliveira, Patricia Moriel, Marília B. Visacri
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      PurposeThe emergence of multidrug-resistant (MDR) Gram-negative bacterial infections in the neonatal intensive care unit (NICU) is a major public health threat. Ceftazidime-avibactam (CAZ-AVI) provides a new option for treating infections caused by most beta-lactamase- and carbapenemase-producing Gram-negative bacteria in infants older than three months. However, treatment options are extremely limited, with no safety data available for preterm neonates. Here, we describe our experience regarding the safety and efficacy of off-label use of CAZ-AVI in a NICU in Brazil.SummaryWe report a case of a premature infant (born at 29 weeks gestational age) treated with CAZ-AVI due to a bloodstream infection caused by MDR Klebsiella pneumoniae.ConclusionTreatment with CAZ-AVI was safe and effective in our patient.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-13T06:44:53Z
      DOI: 10.1177/08971900221087131
       
  • Community Pharmacy Credentialing for Medical Insurance to Facilitate
           Sustainability in COVID-19 Testing

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      Authors: Elaine Nguyen, Patricia M. Healey, Renee Robinson, Jennifer L. Adams, Shanna K. O’Connor
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundIn April 2020, pharmacists were added as medical providers under Idaho Medicaid in response to recent scope expansion for pharmacists and to increase beneficiaries’ access to coronavirus disease 2019 (COVID-19) testing and services. The COVID-19 pandemic prompted expedited Medicaid enrollment for pharmacists but did not address coverage of medical services provided to privately insured individuals for pharmacy-based testing services.ObjectiveThis study aimed to describe processes used by independently owned, community-based pharmacies in Idaho to credential with private insurers and report outcomes.MethodsRelevant information and forms required to credential with the four major payers in the state of Idaho were collected. Packets were obtained via medical insurers’ websites and by direct contact. Questions that arose from community pharmacists during the submission process were collected and answered on a shared spreadsheet, and insurance representatives were contacted directly to resolve questions.ResultsEight out of 13 participating pharmacies submitted an average of three credentialing packets for their facilities. Thirty-five pharmacists also submitted an average of four credentialing packets for themselves. As of mid-May 2021, nearly 20 weeks after submission, only 67 out of 129 pharmacists had received word regarding the status of their applications. Less than half of all pharmacist applications were approved (after their first attempt).ConclusionEfforts to support the education of both pharmacists and medical insurers may streamline the credentialing processes in the future.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-13T06:36:35Z
      DOI: 10.1177/08971900221087129
       
  • Comparison of the Effectiveness of Liraglutide vs Semaglutide in a Veteran
           Population

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      Authors: Krishna B. Rana, Sara R. Britnell, Megan E. Gilbertson, Sarai L. Ibrahim
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundGlucagon-like peptide-1 receptor agonists (GLP-1 RAs) are commonly prescribed medications for patients with type 2 diabetes mellitus (T2DM) based on cardiovascular benefits.ObjectiveThis study aimed to evaluate efficacy and tolerability of once daily liraglutide vs once weekly semaglutide on T2DM in a Veteran population.MethodsThis was a retrospective, single-center, cohort study that included T2DM patients with a prescription for liraglutide or semaglutide between September 1st, 2019, and September 30th, 2020. Patients between groups were matched based on age and insulin use at baseline. The primary endpoint was the difference in hemoglobin A1c (A1c) between the most recent A1c in the study period and baseline A1c obtained prior to GLP-1 RA initiation.ResultsThere were 154 patients included in the study. While mean reduction in A1c was numerically higher in the liraglutide group (−1.1% vs. −.8%), this was not statistically significant (P = .22). The proportion of patients achieving A1c < 7%, < 8%, < 9%, or their patient-specific A1c goal did not differ between groups. Although baseline total daily doses of insulin were higher in the semaglutide group, these patients had numerically greater reductions in total daily dose of insulin and weight from baseline; however, no statistical difference was observed. Adverse drug reactions were more common in the semaglutide group (n = 14 vs. 9), leading to higher discontinuation rates as well (n = 11 vs. 8).ConclusionThe results of this study indicate no difference between liraglutide and semaglutide in terms of A1c-lowering potential, but it provides insights into key considerations for the Veteran population.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-13T06:35:59Z
      DOI: 10.1177/08971900221087127
       
  • Evaluation of the Use of Social Media and Virtual Meeting Platforms in the
           Pursuit of Pharmacy Residency Training

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      Authors: Briann S Fischetti, Christine Ciaramella, Elise M Kim, Irene-Constantina Papamanolis
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      IntroductionThe American Society of Health-Systems Pharmacists (ASHP) and American College of Clinical Pharmacy (ACCP) Residency Directories are two of the more traditional resources available to pharmacy students and residents looking for post-graduate programs. More recently, social media platforms have grown as an innovative means of resident recruitment and program marketing.ObjectiveThe objective of this study was to evaluate the use of social media by both PGY1 and PGY2 candidates in their pursuit of post-graduate training through the disbursement of a survey.MethodsA survey consisting of 14 questions ranging from multiple-choice questions to free-text options was emailed out to the Office of Experiential Education from 141 ACCP-accredited pharmacy schools and 1341 ASHP-accredited PGY1 Pharmacy Residency Program Directors, requesting them to forward the email to their students or residents.ResultsThere were a total of 714 respondents to the survey. A majority of surveyors were in the process of completing a PGY1 residency training program (70.6%). The most common platform used to research pharmacy residency programs was the ASHP directory (97.3%). A majority of respondents did not use social media to research residency programs (66.7%). Out of the ones who did use social media, Instagram was the most common platform used and provided the greatest insight into the residency program. About 60% of respondents preferred Zoom as the virtual meeting platform during interviews.ConclusionAlthough social media may not be the main source of information candidates are using, residency program accounts can provide residency programs with a free additional tool for recruitment.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-12T04:58:20Z
      DOI: 10.1177/08971900221088806
       
  • Evaluation of Discharge Opioid Prescribing in Coronary Artery Bypass
           Patients Following an Opioid Stewardship Intervention for Providers

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      Authors: Justin M. Babino, James Douglas Thornton, Kimberly Putney, Ramsi Bethany Taylor, Matthew A. Wanat
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      IntroductionOpioid stewardship efforts can promote safe and effective use of opioids to optimize pain control and minimize unintended consequences. The purpose of this study is to assess the difference in post-operative opioid discharge prescribing in patients undergoing coronary artery bypass graft (CABG) surgery following implementation of a tripartite opioid stewardship intervention.MethodsThis was a single-center, quality improvement study at a large, quaternary academic medical center. Adult patients undergoing CABG from July 2019 to June 2020 (pre-intervention) and November 2020 to February 2021 (post-intervention) were included. The intervention included adopting hospital-wide post-surgical opioid discharge prescribing guidelines, discharge prescriber education, and electronic medical record changes. The primary outcome was the proportion of patients receiving an opioid prescription at discharge. Secondary outcomes included total morphine milligram equivalents (MME) prescribed and non-opioid analgesics prescribed at discharge.ResultsA total of 200 patients were included in the study; 100 pre- and 100 post-intervention. There was no difference in opioid discharge prescribing at discharge (74% pre-intervention vs. 72% post-intervention; P = .87). There was no difference in MMEs prescribed at discharge (145.6 ± 57 pre- vs. 162.2 ± 95 post-; P = .202). No difference was seen in non-opioid analgesic prescriptions prescribed at discharge (35% pre- vs. 40% post-; P = .56).ConclusionA multipronged opioid stewardship intervention did not lead to a reduction in opioid prescribing at discharge. Post-intervention, there was a non-statistically significant increase in the proportion of patients who received non-opioid analgesics discharge. Future studies should assess the effect of different stewardship interventions on prescribing and patient outcomes.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-12T01:05:10Z
      DOI: 10.1177/08971900221088797
       
  • Suboptimal Dosing of Benzodiazepines and Levetiracetam in a Cohort of
           Status Epilepticus Patients and Outcomes Associated with Inadequate Dosing
           

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      Authors: Kristina R. M. Braun, L. Lisa Pham, Geoffrey C. Wall, Timothy E. Welty
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundStatus epilepticus (SE) is a neurologic emergency that can result in serious morbidity and mortality. Recent studies have suggested underdosing of both benzodiazepines (BZDs) and antiseizure medications (ASM) which may result in poorer outcomes.ObjectivesThis study aims to determine the dose of BZDs and levetiracetam given in our emergency department for episodes of SE and determine the outcomes associated with this dosing.MethodsWe conducted a retrospective cohort study of all adult patients with SE admitted to our hospital from 2017 to 2020. We collected demographic data, type of SE, dose of BZD and levetiracetam, and outcomes which included mortality and a calculated Glasgow outcome scale (GOS). We compared outcomes of patients with SE who received adequate dosing (according to practice guidelines) to those who did not.Results111 adult patients were included of whom 91% were seen initially in our emergency department. 75% had convulsive SE on presentation. Approximately 55% and 68% of patients did not receive an appropriate dose of BZD or levetiracetam, respectively. Inadequate dosing of BZD was associated with worse clinical outcomes based on GOS (43.6% favorable outcome vs 62.5% with adequate dosing P = .046 (95% CI, 1.01–4.60)) and inadequate dosing of both drugs was also associated with a worse GOS outcome (HR, 2.91 (95% CI, 1.05–9.67, P = .02). No difference was found in length of stay or mortality alone.ConclusionOur study found inadequate dosing of drugs to treat SE in adults was common in our institution and was associated with worse outcomes.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-11T01:51:17Z
      DOI: 10.1177/08971900221088804
       
  • A Retrospective Cohort Evaluation of a Pharmacist-Led Approach for
           Transitioning Patients to an Angiotensin Receptor—Neprilysin Inhibitor

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      Authors: Krishna Rana, Jessica Jay, Sonalie Patel, Carla Sueta, Zack Deyo
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundHeart failure guidelines recommend replacing an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) with an angiotensin receptor neprilysin inhibitor (ARNI) to reduce morbidity and mortality in NYHA Class II–III patients with reduced ejection fraction (HFrEF).ObjectiveThis study aims to determine if a pharmacist-led outpatient ARNI replacement and titration program led to more patients achieving target doses of ARNI compared to usual care.MethodsA single health system, retrospective electronic medical record review identified 791 patients with active ARNI prescriptions and at least two outpatient cardiology visits with a pharmacist or usual care provider between January 2015 through September 2018. The primary outcome was the percentage of patients who achieved a target ARNI dose of 97/103 mg twice daily. The secondary outcomes were the median dose achieved, number of visits required to achieve target dose, hospitalizations, and all-cause death.ResultsARNI was initiated and continued by a pharmacist in 64 patients and 727 by usual care. More patients in the pharmacist group, 60.9% (n = 39), achieved target dose vs. 18.0% (n = 131) of patients managed by usual care (95% CI, 0.31–0.55, p < 0.0001). The pharmacist group also had higher median total daily dose of ARNI (200 mg (IQR = 300) vs 100 mg (IQR = 100), p < 0.0001) and more likely to achieve a higher total daily dose in fewer visits.ConclusionsAn advanced practice provider pharmacist-led outpatient ARNI replacement and titration program was more effective in achieving target doses of ARNI in HFrEF patients as compared to usual care.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-08T03:56:50Z
      DOI: 10.1177/08971900221087087
       
  • Use of Sodium Bicarbonate Purge Solution in Impella Devices for
           Heparin-Induced Thrombocytopenia

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      Authors: Adnan M. Al-Ayoubi, Kinnari Bhavsar, Ryan A. Hobbs, Katharyn L. Smith, Leonard Y. Lee, Hirohisa Ikegami, Arun K. Singhal
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Heparin purge solution is recommended to be used in Impella devices to prevent biomaterial buildup and subsequent device dysfunction. The use of sodium bicarbonate purge solution in an Impella device is described in two patients with heparin-induced thrombocytopenia (HIT). The first case details a patient with severe mitral regurgitation and cardiogenic shock who had an Impella CP placed who developed HIT. Heparin purge solution was replaced by sodium bicarbonate purge solution in addition to systemic direct thrombin inhibitor (DTI) initiation. There was no significant change in Impella purge pressure or flow over the 13 days of Impella use. The second case describes a patient who developed an acute myocardial infarction and subsequent cardiogenic shock for which an Impella CP was placed who also developed HIT. Heparin purge solution was replaced by sodium bicarbonate purge solution. There was no significant change in purge pressure, flow, or motor current spikes over 11 days of use. In conclusion, we describe the successful use of a novel sodium bicarbonate purge solution utilized in patients with HIT for Impella management alone and in combination with systemic direct thrombin inhibitor therapy. This resulted in no protein deposition in the device gaps or device dysfunction.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-07T09:13:30Z
      DOI: 10.1177/08971900221089078
       
  • Clinical Advanced Pharmacy Practice Experience Rotations During COVID-19:
           Evaluation of a Transition to Virtual Learning

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      Authors: Casey C. May, Sara A. Atyia, Amanda J. Hafford, Keaton S. Smetana
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundAll Advanced Pharmacy Practice Experience (APPE) pharmacy rotations at a large academic medical center were converted to virtual experiences during the beginning of the coronavirus disease 2019 (COVID-19) pandemic.ObjectiveThis study aimed to describe information obtained through pre- and post-rotation surveys, implemented to improve experiences for future students who may be required to complete virtual APPE pharmacy rotations.MethodsA single-center, descriptive study was conducted at a 1382-bed academic medical center. A pre- and post-rotation survey was sent to 32 students, and a post-rotation survey was sent to 38 preceptors via email to assess newly implemented virtual rotations.ResultsStudents’ response rate for pre- and post-rotation surveys was 59% and 41%, respectively, and the preceptors’ response rate for the post-rotation survey was 37%. A statistically significant improvement in videoconferencing abilities after the rotation was found for students but no differences in other skills were noted. In the post-rotation survey, students rated all of the following areas as being “effective”: rotation as a whole, virtual topic and patient discussions; but were “neutral” regarding the utility of the introductory training guide. In the post-rotation survey, preceptors rated all of the following areas as being “effective”: rotation as a whole, virtual topic and patient discussions.ConclusionAbrupt shifts to virtual pharmacy clinical rotations due to COVID-19 have led to many challenges. Both students and preceptors felt that virtual rotations were an effective alternative to in-person experiences; however, further studies are warranted to evaluate actual performance compared to perceived effectiveness.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-07T05:31:28Z
      DOI: 10.1177/08971900221087116
       
  • Optimization of Medication Point-Of-Prescribing Alerts at a Multi-Site,
           Ambulatory Care Organization to Aid Clinical Care and Reduce HealthCare
           Cost

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      Authors: Thu-Trang Nguyen, Whitney Hollands, Kathy Zaiken
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundLiterature has shown the integration of electronic alerts into patient care has the potential to improve clinicians’ workflow by saving time, increasing efficiency, and improving patient safety. However, despite these possible benefits of alerts, studies have shown that alerts are often overridden by clinicians.ObjectiveThe purpose of this study was to optimize the acceptance rates of medication point-of-prescribing alerts within the electronic medical record (EMR) of an ambulatory care organization.MethodsThe study design evaluated the actions taken by clinicians when they were presented with medication point-of-prescribing alerts. These alerts were created by the clinical pharmacy informatics team to help promote cost-effective and safe prescribing. Alerts determined to be high value alerts were optimized to increase clinicians’ likelihood of accepting each alert’s recommended alternative. The primary objective was to increase acceptance rates of high value alerts. The exploratory objective was to identify the estimated annualized cost-savings when high value alerts were accepted, and a lower cost alternative prescription resulted.ResultsThe acceptance rate of the optimized point-of-prescribing alerts increased to 8.7%, compared to a 3.2% acceptance in the pre-modification period (P
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-07T02:11:20Z
      DOI: 10.1177/08971900221079022
       
  • Developing Medication Therapy Management Training for Community Health
           Professionals Serving Low-Income Patients

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      Authors: Arlesia Mathis, Jocelyn D. Spates, Sandra Suther
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundEach year, medication-related adverse events account for over 1 million emergency department visits according to the Office of Disease Prevention and Health Promotion. Medication therapy management (MTM), a service most commonly performed by health professionals, identifies and resolves medication-related problems and has been shown to both reduce healthcare costs and improve clinical outcomes.ObjectiveThe objective of our project was to expand the use of MTM by developing a training program for health professionals to increase medication adherence for low-income patients at Federally Qualified Health Centers (FQHCs) specifically targeting individuals with hypertension and diabetes.MethodsA needs assessment survey was developed and administered to licensed pharmacists across the state of Florida. Based on the results of the survey, an MTM training program was developed to support pharmacists who serve patients with hypertension and diabetes. The second phase included a pre-assessment administered to the FQHC. The training program was modified based on responses to the pre-assessment.ResultsBased on the FQHC pre-assessment, the team developed MTM support training for health professionals that included 7 modules. These modules were Principles of Chronic Disease Self-Management, Team-Based Care, Client Self-Advocacy, Health Equity, Cultural Competency, Social Determinants of Health, and the Benefits of MTM Services.ConclusionExpanding MTM support training to other health professionals is expected to provide greater access to chronic disease management support, improve patient outcomes and reduce the cost of care for patients. It is also expected over time to reduce the demand for additional chronic disease–related services.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-05T07:29:26Z
      DOI: 10.1177/08971900221077610
       
  • Which “weigh” to Go' Alternative Vancomycin Dosing
           Strategies in Obese Patients

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      Authors: Lauren Wright, Darrell T. Childress, Matthew L. Brown, Wes Wilkerson, Ricardo Maldonado, Spencer H. Durham
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      PurposeThis study aims to compare the performance of alternative weight-based vancomycin dosing strategies to traditional dosing in obese patients using area under the curve (AUC) monitoring.MethodsThis retrospective study compared target attainment of an AUC between 400–600mcg*H/mL using alternative vancomycin dosing strategies. All patients received allometrically dosed vancomycin, with patient-specific AUCs calculated using 2 post-infusion steady-state vancomycin serum concentrations using the trapezoidal rule. Predicted AUCs were calculated using the following: 15 mg/kg total body weight (TBW), 15 mg/kg corrected body weight (CBW), and 12.5 mg/kg TBW. Predicted AUCs from the traditional 15 mg/kg TBW dosing were then compared to alternative dosing strategies using the predicted AUCs from 12.5 mg/kg TBW, 15 mg/kg CBW, and the actual AUCs calculated using allometrically scaled vancomycin dosing. The primary outcome was attainment of initial AUC within the target range of 400–600mcg*H/mL for each dosing method.ResultsEighty-four patients were included. When AUCs were compared to traditional 15 mg/kg dosing strategy, the CBW, 12.5 mg/kg, and allometric dosing strategies were significantly more likely to result in initial attainment of an AUC within a target range of 400–600 mcg*H/mL (P = 0.0003, 0.0135, and 0.0088, respectively). No significant differences were seen between each of the alternative dosing methods (P = 0.73).ConclusionThe 3 alternative vancomycin dosing strategies examined were all significantly more likely to achieve an initial AUC within the target range compared to traditional vancomycin dosing in obese patients. Clinicians should strongly consider one of these alternative dosing strategies for obese patients as opposed to traditional vancomycin dosing.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-04-01T06:23:45Z
      DOI: 10.1177/08971900221087122
       
  • In It for the Long Haul: Post-Acute Sequelae of Severe Acute Respiratory
           Syndrome Coronavirus 2

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      Authors: Rena Gosser, Sarah Anderson, Amie Blaszczyk, Christi Jen, Snehal Bhatt
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      The COVID-19 pandemic has caused immeasurable clinical, economic, and societal challenges for the world since early 2020. Intense focus has been placed on determining evidence-based acute management of patients infected with the SARS-CoV-2 virus, as well as accelerating vaccination efforts for those eligible to receive it. As patients recover from infection, many are left with long-term symptoms, known as “Long COVID” or “Post-Acute Sequelae of COVID19,” that challenges the ability to fully recover, return to baseline health status, and regain quality of life. As the most accessible healthcare professional, pharmacists can assist with the management of long COVID as a member of the multidisciplinary team. Pharmacists' medication acumen is beneficial to the management of long COVID symptomatology as more research comes to the forefront of this deadly disease.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-03-31T10:51:43Z
      DOI: 10.1177/08971900221088799
       
  • Vericiguat: The First Soluble Guanylate Cyclase Stimulator for Reduction
           of Cardiovascular Death and Heart Failure Hospitalization in Patients With
           Heart Failure Reduced Ejection Fraction

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      Authors: Bao-Anh Tran, Erini S. Serag-Bolos, Joel Fernandez, Aimon C. Miranda
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      ObjectiveThis study aims to review the pharmacology, efficacy, and safety of the soluble guanylate cyclase stimulator, vericiguat, in patients with symptomatic congestive heart failure with ejection fraction less than 45% for the reduction of cardiovascular deaths. Also, to evaluate heart failure–related hospitalization in patients following a hospital discharge secondary to heart failure or those that require outpatient intravenous diuretics.Data sourceMEDLINE/Pubmed and National Institutes of Health Clinical Trial Registry were searched between January 1989 to February 2021 using the following terms: vericiguat, soluble guanylate cyclase stimulator, heart failure, (was also known as) BAY 1021189.Study Selection and Data ExtractionThe following study designs were included in the analysis: phase I, II, and III clinical trials; systematic reviews; and meta-analyses. Articles were included if they were published in English and evaluated vericiguat pharmacology, pharmacokinetics, efficacy, and safety.Data SynthesisThe Food and Drug Administration approved vericiguat for the reduction of cardiovascular death and hospitalization after having a related hospitalization or the need for outpatient intravenous diuretics, in those with symptomatic chronic heart failure and ejection fraction less than 45%. In the VICTORIA trial, vericiguat demonstrated a 10% reduction in risk of death from cardiovascular causes or first hospitalization for heart failure compared with placebo. Vericiguat was well tolerated overall with hypotension, syncope, and anemia noted as the most common side effects, similar to the other agent in its class.ConclusionVericiguat may be appropriate as add-on therapy for patients already on guideline-directed medical therapy with recent decompensated HFrEF to reduce hospitalization.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-03-31T10:44:32Z
      DOI: 10.1177/08971900221087096
       
  • New Jersey Pharmacists’ Perceptions on Performing COVID-19 Testing in
           Community Pharmacy Practice Sites

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      Authors: Lindsay A. Brust-Sisti, Mark E. Armanious, Kelly Ohlinger, Jainaben Patel, Tanvi Lodhia, Marc G. Sturgill, Lucio R. Volino
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundPoint of care testing (POCT) for Coronavirus Disease 2019 (COVID-19) is a major source of its control. On May 13, 2020, NJ pharmacists were authorized to order and perform COVID-19 testing, expanding their role in the response to the COVID-19 pandemic.ObjectiveThe purpose of this study was to evaluate NJ pharmacists’ perceptions on the safety and potential consequences of performing COVID-19 testing within their community pharmacy practice sites. Methods: An electronic survey was distributed to NJ-registered pharmacists approximately 3 months after the administrative order was issued.ResultsThe survey was completed by 523 recipients (3.39% response rate) and responses from 311 NJ pharmacists practicing in community pharmacy were analyzed. The majority of respondents (83.8%) were not providing testing, while 16.2% were testing at the time of survey distribution. Most testing pharmacists were staff pharmacists with one to five years of experience, working in a pharmacy chain approximately 30-40 hours per week. Those not testing identified lack of a pharmacy drive-through, insufficient staff, and potential workflow disruption as reasons for not testing. Increased workload and fear of spreading the virus to others were concerns noted by both testers and non-testers.ConclusionOverall, NJ pharmacists reported mixed perceptions regarding performing COVID-19 testing. Challenges and barriers to pharmacist COVID-19 testing, including inadequate staffing and space, and concerns about reimbursement and disruption to workflow were identified. Findings may serve as a guide to design and implement strategies to overcome barriers.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-03-31T06:00:03Z
      DOI: 10.1177/08971900221081629
       
  • Safety and Tolerability of Intravenous Push Lacosamide and Levetiracetam

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      Authors: David Ragoonanan, Nicolas Tran, Melissa Levesque
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundLacosamide and levetiracetam are antiseizure medications (ASMs) commonly utilized in the treatment and prevention of seizures. Historically, these agents have been administered as slow IV infusions after further dilution. Recent literature suggests that rapid administration via undiluted IV push may be safe and may increase efficiency of administration.ObjectiveThis study aimed to evaluate the safety and tolerability of undiluted IV push lacosamide and levetiracetam over 5 min.MethodsThis study was conducted as a single-centered, retrospective, observational cohort that analyzed the rapid administration of undiluted lacosamide and levetiracetam. Adult patients admitted from September 1st, 2019, to May 31st, 2020, receiving at least one administration of IV push lacosamide at any dose or levetiracetam at doses ≤ 1500 mg were evaluated. The primary safety outcomes were the incidence of hypotension and bradycardia.ResultsA total of 86 subjects were evaluated; 36 patients were administered lacosamide, and 50 patients were administered levetiracetam. Hypotension or bradycardia occurred in 6 patients in the lacosamide group (16.6%) and 6 patients in the levetiracetam group (12.0%). There were no reported infusion site reactions. Among the subjects who received lacosamide and had a 12-lead electrocardiogram (EKG), there were no reported incidences of a prolonged PR interval.ConclusionsIn this safety-analysis cohort, undiluted lacosamide and levetiracetam were not associated with significant adverse events when administered via IV push over 5 min. This seems to be a safe alternative method of administration to intermittent infusion. A larger, prospective cohort is needed to confirm these findings.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-03-29T12:15:37Z
      DOI: 10.1177/08971900221087955
       
  • 6-Mercaptopurine and Macrophage Activation Syndrome Case Report and Review
           of the Literature

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      Authors: Lilia Davenport, Jamie Chin-Hon, Juri Chung, Xian Jie Chen, Jeffrey Schneider
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Macrophage activation syndrome is a life-threatening syndrome of uncontrolled immune activation with variable clinical presentation making early diagnosis difficult. It is often manifested by the development of multi-organ failure due to systemic inflammatory response. Patients with ulcerative colitis (UC) on purine antimetabolites are at high risk for severe myelosuppression due to the mechanism of thiopurine toxicity which potentially contributes to the development of macrophage activation syndrome. We present a case of a 39-year-old woman with a 2-year history of UC previously treated with 6-mercaptopurine (6-MP) and recent COVID-19 infection, who was admitted to our emergency department for C. difficile infection and subsequently developed macrophage activation syndrome. This case report also raises the question of whether abrupt discontinuation of 6-MP may have contributed to the worsening of the patient’s symptoms of underlying hemophagocytic lymphohistiocytosis (HLH) and her rapid deterioration. Both macrophage activation syndrome and COVID-19 infection can produce a large number of pro-inflammatory cytokines termed “cytokine storm,” but a pro-inflammatory cytokine panel breakdown helps to differentiate between the two. Our case report emphasizes the importance of close monitoring of patients on purine antimetabolite therapy who present with signs and symptoms of systemic toxicity.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-03-27T04:46:11Z
      DOI: 10.1177/08971900221081617
       
  • A Randomized Controlled Study Addressing Dexamethasone Tolerability in the
           Treatment of Acute Asthma in Children: Mary Poppins on Trial!

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      Authors: Lyn Kathryn Sonnenberg, Douglas Sinclair
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      AimEmesis of oral medications continues to be a problem in the management of acute pediatric asthma exacerbations; therefore, we set out to assess whether smaller volumes of oral dexamethasone resulted in better tolerability.MethodsChildren aged 2–14 years, presenting to the emergency department with acute asthma exacerbation, were enrolled in this open, prospective randomized controlled trial. Participants received 0.3 mg/kg of dexamethasone in either its concentrated volume (10 mg/mL) or mixed with Ora Sweet (1 mg/mL). Tolerability was measured by vomiting within 45 minutes of receiving dexamethasone, with stratification, a priori, for prior vomiting.Results430 participants were enrolled. 23/213 (11%) in the 10 mg/mL group vomited dexamethasone compared to 16/217 (7%) in the 1 mg/mL group (P = .29). 11/179 (6%) in the 10 mg/mL group vomited compared to 8/183 (3%) in the 1 mg/mL group (.61). For those 68 stratified with prior vomiting, 12/34 (35%) in the 10 mg/mL group vomited compared to 8/34 (24%) in the 1 mg/mL group (P = .43). None of these results were statistically different. Prior vomiting increased the risk of vomiting, regardless of the formulation given (P < .001). ConclusionsVolume does not play a significant role in the tolerability of dexamethasone. Therefore, palatability should not be sacrificed for a smaller volume of dexamethasone to improve tolerability.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-03-27T03:15:22Z
      DOI: 10.1177/08971900221076447
       
  • Long-Term Healthcare Cost Savings of a Pediatric Nephrotoxic
           Medication-Associated Acute Kidney Injury Reduction Program in a Simulated
           Sample

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      Authors: Linda Dynan, Danielle Lazear, Stuart L. Goldstein
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundNephrotoxic medication exposure is a common cause of acute kidney injury (AKI) in hospitalized children and is associated with chronic kidney disease (CKD). The pharmacist-reliant NINJA program reduced nephrotoxic medication exposure and associated AKI.ObjectivesWe assess potential healthcare cost savings from reduced CKD by preventing AKI with the NINJA program for a pediatric population through age 21.MethodsWe simulated a cohort of 1000 hospitalized non-critically ill children. From the published literature, 310 develop AKI, 267 survive to 6 months, and 10-70% develop CKD, and NINJA implementation reduced AKI by 23.8%. Allowing for varying CKD rates, we estimated a range of NINJA’s savings. We assumed an annual GFR decline of 1.2 (noHTN) ml/min/1.73 m2 for half the sample and 1.7 (HTN) ml/min/1.73 m2 for the other half to account for CKD progression without and with hypertension (HTN). We model attributable costs including CKD stage-related medications and outpatient visits/tests in 2018 dollars discounted at 3%. We subtract the cost of NINJA screening (daily serum creatinine and pharmacist time) from net savings. We exclude end-stage renal disease (ESRD) and hospitalization costs.ResultsNo intervention estimated CKD related costs are $761,852 to $5,735,027. Post-NINJA cost decreases to $616,086 to $4,312,183 (net savings: $145,766 to $1,422 183). Total savings, accounting for NINJA screening ($256,680) are -$110,914 to $1,1 165 503. The breakeven AKI to CKD conversion rate is 13-14% with growth hormone cost included, and 64-65% without.ConclusionThe NINJA program is likely cost beneficial, with greater savings into adulthood by avoiding/delaying ESRD and its costs.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-03-27T02:53:15Z
      DOI: 10.1177/08971900221074978
       
  • Incidence of Hypotension Associated With Two Different Vasopressin
           Discontinuation Strategies in the Recovery Phase of Septic Shock

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      Authors: Joseph Murata, Mitchell Buckley, Julie Lehn, Sumit K. Agarwal, Byron Stevenson, Brandon Martinez, Robert MacLaren
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      IntroductionSafe and effective vasopressor withdrawal strategies during the recovery phase of septic shock lack consensus and are not addressed in clinical practice guidelines. The purpose of this study was to compare the incidence of clinically relevant hypotension associated with different vasopressin (AVP) discontinuation strategies.MethodsThis was a single-center, retrospective, cohort study, conducted at a university medical center over a three-year period. Adult patients ≥18 years with septic shock were included in the study. Patients were stratified into two groups; patients incrementally weaned from AVP and patients in which AVP was abruptly discontinued. The primary endpoint was to compare the incidence of clinically relevant hypotension between study groups up to 24 hours following discontinuation. Secondary analyses included the incidence of any hypotensive event up to 24 hours after AVP cessation, intensive care unit and hospital length of stay, and in-hospital mortality.ResultsA total of 74 patients (n = 46 AVP wean and n = 28 AVP no-wean) met inclusion criteria and were included in the study. The primary outcome was not statistically different between groups. Clinically relevant hypotension occurred in 24 patients (52.3%) and 16 patients (57.1%) in the AVP wean and AVP no-wean groups, respectively (P = .68). There were no significant differences in any secondary clinical outcome between the two study groups.ConclusionNo differences were found in the incidence of clinically relevant hypotension, length of stay, or mortality between AVP weaning and no-weaning discontinuation strategies. These findings suggest incremental weaning and abrupt withdrawal of AVP are both acceptable discontinuation strategies.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-03-25T07:35:13Z
      DOI: 10.1177/08971900221078270
       
  • Intravenous N-Acetylcysteine in Management of COVID-19: A Case Series

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      Authors: Brandon Chen, Karan Raja, Frantz Pierre-Louis, Mitesh Patel, Ruben Patel, Soo Kang, Nicole Daniel, Mark Attalla, Mona Philips
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      A novel coronavirus, severe acute respiratory syndrome coronavirus-2, was isolated from patients’ lower respiratory tracts in December 2019. As of May 19, 2021, there were over 33 million reported infections and almost 600,000 deaths in the United States. The infection, coronavirus disease-19 (COVID-19), can lead to cytokine storm, with elevations in interleukin-6 (IL-6), IL-10, tumor necrosis factor-α, nuclear factor-kappaB (NF-kappaB), and glutathione reductase. NF-kappaB activation is necessary for further transcription of other pro-inflammatory markers. Glutathione may play a role in modulation of NF-kappaB activation and elevated glutathione reductase may indicate glutathione depletion. Administration of N-acetylcysteine (NAC) may replenish spent glutathione and attenuate over-activation of NF-kappaB. This retrospective case series included 10 patients who were COVID-19 positive and received intravenous NAC in an attempt to attenuate the cytokine storm. Patients’ outcomes were graded based on the World Health Organization symptom severity scale from 0, no evidence of infection, to 8, death. Overall, the median WHO Scale prior to NAC was 6.5, and increased by day seven, which indicated clinical worsening. This retrospective case series showed no benefit of NAC; however, further studies are needed to elucidate if differences in drug regimens would lead to positive results.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-03-25T06:30:02Z
      DOI: 10.1177/08971900221080283
       
  • Barriers to Community Pharmacists Referring Patients With Suspected
           COVID-19 Symptoms

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      Authors: Mohamed Bahlol, Zachary Z. Sum, Rebecca Susan Dewey
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundWith the necessary skills available to community pharmacists, they are well equipped to relieve pressure on hospitals and general practices by providing referral services for symptomatic patients for COVID-19 testing.ObjectiveThe assessment of potential barriers that limit the successful implementation of a community pharmacy referral service for patients with suspected COVID-19 symptoms.MethodsA questionnaire comprising of 100 questions was administered to one pharmacist by interview in 1023 working community pharmacies in 4 regions of Egypt between May 17 and May 30th 2020.ResultsForty-five barriers were identified. Respondents (79%, n = 803) had difficulty obtaining an accurate patient history. Patient data confidentiality was a significant issue for pharmacists who had not received referral training, with these respondents being significantly (P = .010) less able to differentiate between COVID-19 and similar conditions. Respondents (68.8%, n = 698) were not confident in determining whether COVID-19 was the cause of the patient’s presenting symptoms. A large majority (73.7%, n = 747) of respondents were worried about referring misdiagnosed patients and were concerned about the negative implications of proceeding with such a referral, including legal consequences. Of Respondents (71.7%, n = 727) reported that online referral was not easy, and 71.6% (n = 722) were unable to locate paper referral forms. Only a small number of pharmacists (11%, n = 112) preferred to report a referral in their own name.ConclusionsThis study has demonstrated the potential of the community pharmacist’s role as a point of referral for COVID-19 testing, and identified some major barriers to implementation of this. The lack of pharmacists’ education, legal support, availability of referral forms, clarity of responsibility and unsupportive management teams are key obstacles that must be overcome for the successful implementation of a COVID-19 referral service.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-03-25T04:49:25Z
      DOI: 10.1177/08971900221074952
       
  • North Carolina Pharmacists’ Support for Hormonal Contraception
           Prescription Status Change

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      Authors: Rachel A. Parry, Gwen Seamon, Mollie Ashe Scott, Casey R. Tak
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundPharmacist-prescribed hormonal contraception (HC) may offer additional avenues of access for patients; however, it is unknown whether pharmacists would support over-the-counter access to contraception over pharmacist-prescribed models.ObjectiveThe objective of this study was to understand how North Carolina (NC) pharmacists believed HC should be classified and how pharmacist and pharmacy characteristics were associated with those beliefs.MethodsThis study was a secondary analysis of a cross-sectional, anonymous, online survey completed by 587 licensed NC pharmacists. The primary outcome of interest was how pharmacists believed HC should be classified: prescription-only, pharmacist-prescribed, behind-the-counter, or over-the-counter. Multinomial bivariate and multivariable regression analyses were conducted to describe the association between pharmacist and pharmacy characteristics with the outcomes of interest through odds ratios and adjusted odds ratios, respectively. Chi-square tests were used to examine the association of geographic location with distribution of attitudes toward HC classification.ResultsFifty-one percent of NC pharmacists supported classification of HC as pharmacist-prescribed, while 23% supported non-prescription (behind- or over-the-counter) classification. Controlling for pharmacist demographics and pharmacy characteristics, completing residency training was significantly associated with supporting pharmacist-prescribed vs prescription-only classification (adjusted odds ratio (aOR) = 2.55, P = .02). Pharmacists had higher odds of supporting pharmacist-prescribed vs prescription-only HC if they agreed that they were well trained to do so (aOR = 3.14, P < .01). Distribution of attitudes about classification of HC did not significantly differ by geographic location (P = .14).ConclusionsMost NC pharmacists support deviating from the current prescription-only classification of HC, with more support for pharmacist-prescribed classification. Continuing education programs should focus on training pharmacists to feel more confident prescribing HC.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-03-24T11:34:51Z
      DOI: 10.1177/08971900221074966
       
  • Practical Approaches to Antipsychotic-Associated Corrected QT Interval
           Prolongation in Patients With Serious Mental Illness: A Review of Cases

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      Authors: Alexandra L. Cunha, Shaina E. Schwartz, Julie B. Cooper
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundThere is no consensus for assessment and management of patients with serious mental illness (SMI) who are at risk for cardiac morbidity and mortality due to antipsychotic-associated QTc prolongation.ObjectiveThe objective of this review was to assess methods for risk scoring, QT correction calculation, and clinical management in SMI patients with antipsychotic-associated QTc prolongation.MethodsA search was performed in PubMed for case reports that described QTc prolongation in adult patients with schizophrenia or bipolar disorder prescribed an antipsychotic. Reports published in North America between 2000 and 2020 were eligible. The Mayo, Tisdale, and RISQ-PATH scoring tools were applied to cases to categorize risk level.ResultsSeventeen cases were included. Most patients were prescribed a second-generation antipsychotic for schizophrenia, with baseline and maximum QTc values of 429 milliseconds and 545 milliseconds, respectively. The Mayo scoring tool identified 17 (100%) cases as “high risk,” Tisdale identified 9 (53%) cases as “moderate risk” and 7 (41%) cases as “low risk,” while RISQ-PATH identified 9 (53%) cases as “not low risk” and 8 (47%) cases as “low risk.” Three cases reported the QT correction formula utilized (18%). The most common intervention to address antipsychotic-associated QTc prolongation was switching to a different antipsychotic (35%). Approximately one third of patients experienced Torsades de Pointes.ConclusionThere is a lack of standardization for antipsychotic-associated QTc prolongation risk assessment and management in patients with SMI. This review provides real-world data representing actual clinical practice.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-03-24T11:31:10Z
      DOI: 10.1177/08971900221078249
       
  • Parenteral Nutrition Total Energy Dosing and Risk for Central
           Line–Associated Bloodstream Infection: A Case-Control Study

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      Authors: Abbie N. Rosen, Robert C. Ross, Kenneth K. Tran, Andrew J. Franck
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundCentral line–associated bloodstream infection (CLABSI) is a complication of central venous access devices used for parenteral nutrition (PN). PN overfeeding is associated with increased adverse effects; however, whether risk for CLABSI is influenced by PN dosing is uncertain.ObjectiveThe purpose of the study was to assess differences in CLABSI risk associated with recommended total energy dosing in hospitalized adult patients receiving PN.MethodsA case-control study was conducted in a single United States Veterans Health Administration health system to assess the potential CLABSI risk factor of weight-based PN kilocalorie dosing. Hospitalized adult patients who developed CLABSI while receiving PN were identified and compared to a control group of patients who did not develop CLABSI. The exposures evaluated were overfeeding, defined as greater than 30 kcal/kg/day, and underfeeding, defined as less than 20 kcal/kg/day.ResultsTwenty-nine cases of CLABSI were identified and compared with 274 controls. Odds of CLABSI were significantly higher in patients receiving greater than 30 kcal/kg/day (OR, 3.63; 95% CI, 1.55-8.48; P < .01). No significant difference in odds was found for patients receiving less than 20 kcal/kg/day (OR, .74; 95% CI, 0.21-2.57; P = .63).ConclusionIncreased risk for CLABSI in hospitalized adult patients receiving PN was found to be associated with overfeeding, but not underfeeding. These results may aid clinicians in the management of patients requiring PN and in the generation of hypothesis for future investigations.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-03-24T02:48:05Z
      DOI: 10.1177/08971900221074932
       
  • The Use of Simulation Based Learning: With Bachelor of Science
           Pharmaceutical Science and PharmD Students

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      Authors: Justin L. Gold, Amanda M. Chichester, Clinton O. Chichester
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background and purposeInterprofessional education between bachelor of science pharmaceutical science (BSPS) students and Doctor of Pharmacy (PharmD) students is rare. According to the Association of American Medical Colleges, more than 80% of medical schools incorporate simulation based teaching within all four years of the curriculum.Educational activity and settingThe University of Rhode Island College of Pharmacy healthcare simulation lab has developed integrated educational opportunities for both groups of students by offering independent study opportunities that allow BSPS students to collaborate with PharmD students. A recent example of this model includes BSPS student development of patient cases which are integrated into high-fidelity human patient simulators with faculty assistance. A senior BSPS student researched and designed four clinical patient cases which were presented to P3 pharmacy students.FindingsIn all four cases, there was an increase in knowledge and attitudes following the simulation. Qualitative comments from students noted the importance of patient education and an enhanced ability to manage disease and side effects.SummaryThe nature of the simulation lab at the University of Rhode Island is a platform that can be modeled by other institutions with both PharmD and BSPS programs.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-03-18T04:47:08Z
      DOI: 10.1177/08971900221082782
       
  • Infectious Diseases Virtual Topic Discussions: Co-preceptorship
           Adaptations During a Global Pandemic

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      Authors: Bryan P. White, Athena L. V. Hobbs
      Abstract: Journal of Pharmacy Practice, Ahead of Print.

      Citation: Journal of Pharmacy Practice
      PubDate: 2022-03-11T01:39:19Z
      DOI: 10.1177/08971900221076427
       
  • Standardizing Lower Heparin Concentrations for Use in Anticoagulation of
           Percutaneous Left Ventricular Assist Device (pVAD) D5W Purge Solutions

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      Authors: Aaron M. Chase, Nathaniel B. Wayne, Andrea Sikora
      Abstract: Journal of Pharmacy Practice, Ahead of Print.

      Citation: Journal of Pharmacy Practice
      PubDate: 2022-03-02T10:47:54Z
      DOI: 10.1177/08971900211055357
       
  • Case Report: Extended Duration Andexanet Alfa Infusion in a Surgical
           Trauma Patient

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      Authors: Carolyn D. Philpott, Neil E. Ernst, Amy T. Makley, Peter R. Wasky, Eric W. Mueller
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundAndexanet alfa (andexanet) is the only FDA-approved medication for reversal of apixaban and rivaroxaban anticoagulation for life-threatening or uncontrolled bleeding. Infusion modifications may be required in surgical patients undergoing prolonged operative intervention but have not previously been described.Case ReportA 78-year-old woman on rivaroxaban for atrial fibrillation was admitted to the trauma service for a mechanical fall, sustaining a T4 burst fracture with severe canal stenosis and spinal cord edema resulting in loss of strength and sensation in her legs. Clinically relevant rivaroxaban activity was verified with an elevated low molecular weight heparin anti-factor Xa assay, and laboratory confirmed coagulopathy was demonstrated by a prolonged prothrombin time, thromboelastography (TEG) R-time, and activated clotting time (ACT). The patient required urgent surgical intervention for spinal fixation. Given the expected prolonged duration of the procedure, standard dose andexanet was initiated with a prolonged infusion at half the standard rate during the operation. The procedure was successful and intraoperative TEGs demonstrated normalization of R-time and ACT throughout the procedure. The patient did not experience any complications postoperatively and successfully discharged to inpatient rehabilitation.ConclusionModifications to the andexanet infusion may be required in surgical patients requiring rivaroxaban reversal for a prolonged procedure. Further data are needed to determine the optimal approach to infusion modification.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-03-01T03:14:55Z
      DOI: 10.1177/08971900221078779
       
  • Evaluation of Intravenous Push Piperacillin-Tazobactam on Time to
           Antibiotic Administration in Emergency Department Patients with Sepsis

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      Authors: Mohammed A. Alrashed, Nayoung Kang, Stephen J. Perona, Mohammad R. Torabi, Mark C. Borgstorm
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Purpose: The purpose of this study was to determine if intravenous push (IVP) administration of piperacillin-tazobactam reduced the time to antibiotic administration compared to intravenous piggyback (IVPB) in emergency department (ED) patients who present with sepsis. Methods: This was a retrospective cohort study of patients with sepsis who received piperacillin-tazobactam before and after implementation of an IVPB to IVP conversion protocol. Results: A total of 486 charts were reviewed and the final analysis included 127 patients in each group. The mean time to administration of piperacillin-tazobactam was 67 (± 48) minutes and 58 (± 36) minutes in the IVPB and IVP cohorts, respectively (P = NS). The time to administration of secondary antibiotics was reduced by 38 minutes in patients who received piperacillin-tazobactam by IVP (105 min ±69 vs 67 min ±37; P < .001). Nurse administration time was reduced by 11 min for piperacillin-tazobactam (54 min ±46 vs 43 min ±33; P = .034) and 40 min for secondary antibiotics (90 min ±67 vs 50 min ±32; P = < .001) in the IVP group. There was no difference in hypersensitivity reactions, hospital length of stay, or mortality. Conclusion: Conversion from piperacillin-tazobactam IVPB to IVP was associated with a reduction in time to piperacillin-tazobactam and secondary antibiotic administration in emergency department patients with sepsis. Further prospective research is needed to evaluate clinical outcomes associated with IVP administration.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-02-27T01:41:43Z
      DOI: 10.1177/08971900211061937
       
  • Efficacy of Hepatitis B Vaccine in Adults with Chronic Liver Disease

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      Authors: Yaeji Kim, Jennifer Loucks, Meera Shah
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background & AimsAlthough HBV vaccine has a 95% seroconversion rate in the general population, patients with chronic liver disease have reduced seroconversion rates (16-79%). The aim of the study was to describe seroconversion rates with HBV vaccines in patients with chronic liver disease.Approach & ResultsRetrospective chart review was performed among 652 patients who received a complete HBV vaccine series in the hepatology clinic. Of those, 126 patients that were included, 111 received a single dose series, and 15 patients received a double dose series. The seroconversion rate was overall low at 35%, and stayed the same at 35% with double dose and at 33% with single dose. Patients who received a single dose series were further analyzed to review risk factors for seroconversion. Overall, 65% of patients had cirrhosis. Patients were more likely to seroconvert if no cirrhosis (51% vs 72%, P=.04), higher aminotransferase levels, intermediate anti-HBs (2.5-11.9 mIU/mL) at baseline (87.5% vs 14%)ConclusionPatients with chronic liver disease had a low rate (35%) of response to HBV vaccination. The response rates did not improve in patients that received double dose series. Patients with cirrhosis, lower aminotransferase levels and with a lower baseline anti-HBs had decreased response rates.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-02-24T11:21:16Z
      DOI: 10.1177/08971900221078742
       
  • Colistin (Polymyxin E) Use in Abdominal Solid Organ

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      Authors: Radhika T. Krishnakumar, Amrita Asok, Zubair U. Mohamed, Uma D. Padma, Dipu T. Sathyapalan, Merlin Moni, Sabarish Balachandran, Anil V. Kumar, Rajesh Nair, Surendran Sudhindran, Sanjeev K. Singh
      Abstract: Journal of Pharmacy Practice, Ahead of Print.

      Citation: Journal of Pharmacy Practice
      PubDate: 2022-02-24T05:07:43Z
      DOI: 10.1177/08971900221074967
       
  • Pharmacists’ Knowledge and Perceptions of Health Literacy

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      Authors: Pilar Z. Murphy, Ashton P. Jester
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundHealth literacy is defined as the degree to which individuals have the capacity to obtain, process and understand basic health information needed to make appropriate health decisions. A review of literature revealed few studies that examined pharmacist’s knowledge of health literacy.MethodsThe Pharmacist Professional Health Literacy Survey was distributed to a convenience sampling of community pharmacists in medically underserved counties of Southwest Georgia.ResultsOf 75 pharmacists contacted, 39 completed the survey and were used in the evaluation. Most respondents reported no health literacy training and had never assessed health literacy with a validated questionnaire. More than half of the participants cited lack of knowledge about low health literacy as a major barrier to implementing health literacy screening for their patients. Time and cost were identified as major barriers to participating in health literacy training programs.ConclusionMost pharmacists from this area had little exposure to evaluating health literacy. Pharmacy education postgraduate programs and continuing education training programs around this topic will heighten health literacy knowledge for the pharmacy profession. There is a need for a quick, easy to use, and effective tool for pharmacists to recognize and assess health literacy in patients.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-02-24T02:57:07Z
      DOI: 10.1177/08971900221074958
       
  • Efficacy and Safety of Immediate-Release Nifedipine in Critically Ill
           Patients

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      Authors: Stephanie L. Seto, Megan E. Barra, Arzo Hamidi, Jonathan H. Sin, Lauren T. Devine
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundImmediate-release nifedipine (IRN) is a calcium channel blocker with potent vasodilatory and antihypertensive properties. Safety concerns led to a black box warning for increased risk of myocardial infarction, stroke, and arrhythmias.ObjectiveThe aim of this study was to evaluate the safety and efficacy of IRN for acute blood pressure lowering in critically ill patients.MethodsA retrospective, single-center study was performed in critically ill patients who received at least one dose of IRN. The primary endpoint was the change in systolic blood pressure (SBP) measured at baseline and 1 hour after first administration of IRN. Secondary outcomes included clinically significant hypotension, defined as an absolute reduction in SBP ≥ 15% or vasopressor initiation within 1 hour after administration; incidence of arrhythmias, stroke, or myocardial injury; and time to transition off antihypertensive infusions.ResultsIRN resulted in a median [interquartile range] SBP change of −10 [−21 to −1] mmHg between baseline 142 mmHg [124-155] and 1 h post-administration 127 mmHg [114-144]; P < .001. Twenty-seven percent of patients experienced clinically significant hypotension, with hypotension observed in 24% and vasopressors initiated in 4% of patients. Sixteen percent of patients experienced new-onset arrhythmia and 18% experienced myocardial injury following IRN during hospitalization. Median time to transition off intravenous (IV) continuous infusion antihypertensives was 8.5 [0-31.5] hours.ConclusionIRN led to a reduction in SBP which may have been associated with clinically significant hypotension and need for vasopressor support. Further studies with direct comparisons to alternatives are needed to determine the true association of adverse events with IRN.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-02-14T09:46:40Z
      DOI: 10.1177/08971900221074953
       
  • Clinical Utilization of Stress Dose Hydrocortisone in Adult Patients With
           Septic Shock: A Retrospective Observational Study at a Large Academic
           Medical Center

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      Authors: Gretchen L. Sacha, Alyssa Y. Chen, Nicole M. Palm, Xiaofeng Wang, Manshi Li, Abhijit Duggal
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: The use of stress dose corticosteroids, specifically, hydrocortisone, in septic shock is heterogeneous, and current clinical trials yield conflicting results. Regardless, they are still recommended by guidelines for vasopressor-dependent septic shock. Objectives: This study sought to characterize current practice of hydrocortisone use in patients with septic shock and secondarily to compare clinical outcomes of those who received hydrocortisone to those who did not. Methods: This single center, retrospective cohort study evaluated patients with septic shock admitted to a tertiary care center between 2012 and 2017. Patients receiving hydrocortisone for at least two doses were compared to those without. Results: 3411 septic shock patients were included; 1593 (47%) received hydrocortisone and 1818 (53%) did not. Patients who received hydrocortisone had higher lactate (4.0 vs 3.4 mmol/L; P < .01) and Acute Physiology and Chronic Health Evaluation (APACHE) III scores (104.1 vs 91.0; P < .01). Vasopressor duration was 1.7 days longer in the hydrocortisone group (P < .01), and the hydrocortisone group had higher hospital mortality (52% vs 38%; P < .01). A propensity score–matched population was conducted in patients with APACHE scores>100: vasopressor duration was longer in those who received hydrocortisone (3.9 vs 2.0 days; P < .01), and hospital mortality was higher (59.3% vs 53.1%; P = .036); however, after multivariable adjustment, no association between receipt of hydrocortisone and hospital mortality was detected (OR 1.2 [95% CI .9–1.6]). Conclusions: Patients who received hydrocortisone were more severely ill than those that did not, making retrospective evaluation of this question challenging. These results highlight the wide variability and heterogeneity in hydrocortisone use in clinical practice.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-02-12T10:44:23Z
      DOI: 10.1177/08971900211037589
       
  • Use of Apixaban in Atrial Fibrillation With Ritonavir-Boosted
           Antiretroviral Therapy: A Case Report

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      Authors: Veronica Lomakina, Stephen J. Sozio, Jowana Tekle
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      PurposeDirect oral anticoagulants (DOACs) pose a challenge when given with potent CYP3A4 and P-gp inhibitors, such as the commonly prescribed pharmacokinetic booster ritonavir. As per the manufacturer, apixaban offers a dose reduction when administered concurrently with ritonavir; thus, we explore the clinical indication and safety of apixaban when given with ritonavir-boosted highly active antiretroviral therapy (HAART) in an HIV patient.SummaryWe describe a 73-year-old male with extensive cardiac history, including a past medical history of resolved left ventricular thrombus, newly diagnosed non-valvular atrial fibrillation treated with warfarin, and HIV infection treated with ritonavir-boosted HAART. The patient presented to the emergency department with bleeding from multiple sites, necessitating the use of vitamin K. Consequently, his hospital course was complicated by episodes of minor bleeding and labile INR. Due to the complicated nature of his condition and the potential for drug-drug interactions (DDIs), he was transitioned from warfarin to apixaban. Since there is little readily available data to support the use of rivaroxaban and dabigatran with ritonavir, our patient was safely started on dose-reduced apixaban for stroke prophylaxis in atrial fibrillation due to the predictable nature of apixaban pharmacokinetics and proven superiority regarding adverse effects, as compared to other DOACs.ConclusionDose-reduced apixaban is a safe and viable choice in patients with atrial fibrillation warranting stroke prophylaxis while concurrently receiving ritonavir-boosted HAART.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-02-09T06:33:52Z
      DOI: 10.1177/08971900221074938
       
  • Impact of Initial Therapy on Readmissions in Minority Versus White
           Populations With Heart Failure

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      Authors: Riley D. Bowers, Carrie N. Baker, Katie K. Dircksen, Nicolas L. Biondi
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundMinority populations are often underrepresented in landmark trials for the management of heart failure with reduced ejection fraction (HFrEF). Major trials shaping the guidelines sometimes include as few as 5% black patients.ObjectiveThe purpose of this pilot study was to evaluate the initiation of guideline-directed medical therapy (GDMT) for HFrEF on hospital discharge for minority vs white populations and its impact on all-cause 30-day readmission rates to identify areas for larger future research studies and opportunities for pharmacist intervention.MethodsA retrospective analysis was conducted on patients with HFrEF patients discharged over a 3-month period. The primary objective was to compare all-cause 30-day readmissions in minority vs white patients with HFrEF who were discharged on initial GDMT.Results300 patients were included in this study, with 188 patients in the minority group and 112 patients in the white group. The minority group was predominantly African American (92%). The primary endpoint demonstrated significantly higher 30-day all-cause readmissions in minority patients compared to white patients who received initial GDMT (20.5 vs 7.7%, P = .0144), despite similar rates of GDMT therapy between groups.ConclusionInitial GDMT in minority patients may not reduce readmissions to the same extent seen in white patients. Special emphasis should be placed on evaluating minority patients with HFrEF for additional therapeutic interventions.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-02-08T10:11:58Z
      DOI: 10.1177/08971900221074963
       
  • Impact of Drug Interactions on Major Bleed Rates in Patients Taking Direct
           Oral Anticoagulants

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      Authors: Hannah E. Cook, Jennie H. Hewitt, Emily P. Patterson, Amy E. Randolph
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      Background: While direct oral anticoagulants (DOACs) have less stringent monitoring, favorable pharmacokinetics, and fewer drug interactions compared to warfarin, there is still a potential for drug–drug interactions. There is limited evidence showing total impact of DOAC drug interactions on major bleeding events. Methods: This was an IRB-approved retrospective, case control, single center study. Patients were included if they had received a DOAC from January 2012 to September 2019 and were identified for major bleeding events and matched to a control group. The primary objective was to compare the presence of major drug interactions between patients on DOACs who did and did not have a major bleeding event. The secondary objectives were to compare the impact of specific interacting drug classes and their additive effects on major bleeding events. Results: There were 122 patients included in the study. While the number of patients on at least one interacting medication within duration of DOAC use was numerically higher in the bleed group (85% vs 72%), this was not significant (P = .077). There were significantly more patients on at least three interacting medications within the last 3 months of the study period in the bleed group (n = 9 vs 1), with significantly higher use of aspirin (n = 38 vs 17) and rate control agents (n = 24 vs 11). Conclusion: There may be a cumulative effect on risk of bleeding if patients are on three or more interacting medications concomitantly with a DOAC. This risk of bleeding may be higher with aspirin and rate control agents.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-02-08T03:16:11Z
      DOI: 10.1177/08971900211059411
       
  • D-Cycloserine-Induced Seizure Activity in the Emergency Department: A Case
           Report

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      Authors: Shannon Kuhrau, Tracy Boykin, Megan A. Rech
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      D-cycloserine (DCS) is an anti-tuberculosis medication that has been utilized for years for drug-resistant tuberculosis. DCS works via a centrally acting mechanism which can cause neurotoxic adverse effects which has limited its use. This centrally acting mechanism also allows for DCS to be utilized for various neuropsychiatric purposes. Our patient was on high-dose DCS for autism spectrum disorder and presented to the emergency department (ED) with a seizure. The seizure episode was managed with both anti-epileptics and pyridoxine. With increasing novel use of this older medication, it is imperative for ED clinicians to be aware of the different management strategies that may be required when a patient presents with a neurotoxic effect, specifically seizures, secondary to DCS.
      Citation: Journal of Pharmacy Practice
      PubDate: 2022-02-03T08:00:20Z
      DOI: 10.1177/08971900221074955
       
  • Emergency Department Management of Acute Venous Thromboembolism in
           Patients With Obesity With Intravenous Unfractionated Heparin and Anti-Xa
           Monitoring

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      Authors: Dion J. Tyler, Kelsea A. Caruso, Abbie E. Lyden, Katrina M. Karpowitsch
      Abstract: Journal of Pharmacy Practice, Ahead of Print.
      BackgroundUnfractionated heparin (UFH) remains a frequently utilized agent in the emergency department (ED) for management of acute venous thromboembolism (VTE). While various protocols of UFH dosing have been proposed for patients with obesity, the optimal dosing and monitoring strategy is unclear.ObjectiveThis study aims to compare the time to the first therapeutic anti-Xa level in obese acute VTE patients following the use of either total body weight (TBW) or adjusted body weight-based (AdjBW) dosing of UFH in the ED, and to analyze the impact of different dosing strategies on patient outcomes.MethodsInclusion criteria included adult patients with a BMI> 30 kg/m2, and suspected VTE managed with UFH per institutional protocol utilizing a bolus dose followed by maintenance infusion and anti-Xa monitoring. The primary outcome was time to the first therapeutic anti-Xa level in the group dosed per TBW compared with the group dosed per AdjBW. Safety outcomes included incidence of bleeding events, protamine administration, and mortality.ResultsThere were 32 patients included in the study. Patients dosed per TBW achieved a median time to first therapeutic anti-Xa level of 14.5 hours compared with 15 hours in the AdjBW group (P = .613). The median therapeutic UFH infusion rate was 16 units/kg/hr in the TBW group compared with 13.5 units/kg/hr in the AdjBW group (P < .001). Safety outcomes were not significantly different between groups.ConclusionPatients presenting to the ED with acute VTE may be managed with UFH using either a TBW or AdjBW dosing strategy.
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